Uterine niche: Difference between revisions

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'''Uterine niche''' refers to a small indentation or defect at the site of a previous cesarean section scar in the uterus. This condition is also known as a cesarean scar defect or niche. It is identified through imaging techniques such as [[ultrasound]] or [[magnetic resonance imaging (MRI)]]. Uterine niches are of clinical importance due to their association with postmenstrual spotting, pelvic pain, and potential complications in subsequent pregnancies.
{{SI}}
 
{{Infobox medical condition
==Causes==
| name                    = Uterine niche
The primary cause of a uterine niche is the healing process following a cesarean section (C-section). Not all women who undergo a C-section will develop a niche; the risk may be influenced by surgical techniques, the healing capacity of the individual, and other factors such as infection.
| image                  = [[File:Uterine_Niche.png|250px]]
 
| caption                = Diagram of a uterine niche
==Symptoms==
| field                  = [[Obstetrics]] and [[Gynecology]]
Many women with a uterine niche may not experience any symptoms. However, when symptoms do occur, they can include:
| synonyms                = Cesarean scar defect, isthmocele
* Postmenstrual spotting or bleeding
| symptoms                = Abnormal uterine bleeding, pelvic pain, infertility
* Pelvic pain
| complications          = [[Infertility]], [[ectopic pregnancy]], uterine rupture
* Infertility (in some cases)
| onset                  = Post-cesarean section
 
| duration                = Chronic
==Diagnosis==
| causes                  = [[Cesarean section]]
Diagnosis of a uterine niche typically involves imaging studies. The most common methods include:
| risks                  = Multiple cesarean sections, surgical technique
* [[Transvaginal ultrasound]]: A high-resolution ultrasound probe is inserted into the vagina to get a close view of the uterus and the scar area.
| diagnosis              = [[Ultrasound]], [[Hysteroscopy]], [[Magnetic resonance imaging|MRI]]
* [[Saline infusion sonohysterography (SIS)]]: This technique involves the injection of saline into the uterus during ultrasound imaging to enhance the visualization of the uterine cavity and the niche.
| differential            = [[Adenomyosis]], [[Endometriosis]], [[Uterine fibroids]]
* [[Magnetic resonance imaging (MRI)]]: MRI may be used when a more detailed image of the uterine structure is required.
| prevention              = Optimal surgical technique during cesarean section
 
| treatment              = [[Hysteroscopic surgery]], [[Laparoscopic surgery]]
==Treatment==
| medication              = [[Hormonal therapy]]
Treatment options for a uterine niche depend on the severity of symptoms and the patient's reproductive plans. Options may include:
| frequency              = Common in women with previous cesarean sections
* Expectant management for asymptomatic women or those with mild symptoms.
}}
* Hormonal therapy to reduce bleeding and pain.
A '''uterine niche''' is a defect in the [[myometrium]] at the site of a previous [[cesarean section]] scar. It is also known as a cesarean scar defect or isthmocele. This condition can lead to various gynecological symptoms and complications, including abnormal uterine bleeding, pelvic pain, and secondary infertility.
* Surgical intervention, such as laparoscopic or hysteroscopic repair, may be considered for symptomatic niches, especially in women desiring future pregnancies.
== Anatomy and Pathophysiology ==
 
The uterine niche is typically located at the lower segment of the [[uterus]], where the cesarean section incision was made. The defect occurs when the myometrial tissue does not heal properly, resulting in a pouch or indentation. This can cause the endometrial lining to become trapped, leading to the accumulation of menstrual blood and other symptoms.
==Complications==
== Clinical Presentation ==
Complications related to uterine niches primarily concern future pregnancies. These can include:
Patients with a uterine niche may present with:
* Difficulty in conceiving
* [[Abnormal uterine bleeding]], particularly postmenstrual spotting
* Increased risk of uterine rupture during pregnancy
* [[Pelvic pain]]
* Placental abnormalities such as placenta previa or placenta accreta
* [[Dysmenorrhea]]
 
* [[Dyspareunia]]
==Prevention==
* Secondary [[infertility]]
Preventive strategies focus on minimizing the risk of niche formation after a C-section. These include:
== Diagnosis ==
* Optimal surgical techniques during cesarean delivery
The diagnosis of a uterine niche is typically made using imaging techniques such as:
* Consideration of vaginal delivery if appropriate in subsequent pregnancies
* [[Transvaginal ultrasound]]
 
* [[Sonohysterography]]
==See Also==
* [[Magnetic resonance imaging]] (MRI)
These imaging modalities can help visualize the defect and assess its size and depth.
== Treatment ==
Treatment options for a uterine niche depend on the severity of symptoms and the patient's reproductive plans. They may include:
* [[Hysteroscopic surgery]] to resect the niche
* [[Laparoscopic surgery]] for more extensive repair
* Hormonal therapy to manage symptoms
== Prognosis ==
The prognosis for patients with a uterine niche varies. Surgical repair can alleviate symptoms and improve fertility outcomes, but the success rate depends on the size and location of the niche.
== See also ==
* [[Cesarean section]]
* [[Cesarean section]]
* [[Ultrasound]]
* [[Myometrium]]
* [[Magnetic resonance imaging (MRI)]]
* [[Endometrium]]
* [[Saline infusion sonohysterography (SIS)]]
* [[Infertility]]
* [[Placenta previa]]
* [[Placenta accreta]]
 
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Obstetrics]]
[[Category:Reproductive system]]
{{Med-stub}}

Latest revision as of 19:34, 8 April 2025

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Uterine niche
Synonyms Cesarean scar defect, isthmocele
Pronounce N/A
Specialty N/A
Symptoms Abnormal uterine bleeding, pelvic pain, infertility
Complications Infertility, ectopic pregnancy, uterine rupture
Onset Post-cesarean section
Duration Chronic
Types N/A
Causes Cesarean section
Risks Multiple cesarean sections, surgical technique
Diagnosis Ultrasound, Hysteroscopy, MRI
Differential diagnosis Adenomyosis, Endometriosis, Uterine fibroids
Prevention Optimal surgical technique during cesarean section
Treatment Hysteroscopic surgery, Laparoscopic surgery
Medication Hormonal therapy
Prognosis N/A
Frequency Common in women with previous cesarean sections
Deaths N/A


A uterine niche is a defect in the myometrium at the site of a previous cesarean section scar. It is also known as a cesarean scar defect or isthmocele. This condition can lead to various gynecological symptoms and complications, including abnormal uterine bleeding, pelvic pain, and secondary infertility.

Anatomy and Pathophysiology[edit]

The uterine niche is typically located at the lower segment of the uterus, where the cesarean section incision was made. The defect occurs when the myometrial tissue does not heal properly, resulting in a pouch or indentation. This can cause the endometrial lining to become trapped, leading to the accumulation of menstrual blood and other symptoms.

Clinical Presentation[edit]

Patients with a uterine niche may present with:

Diagnosis[edit]

The diagnosis of a uterine niche is typically made using imaging techniques such as:

These imaging modalities can help visualize the defect and assess its size and depth.

Treatment[edit]

Treatment options for a uterine niche depend on the severity of symptoms and the patient's reproductive plans. They may include:

Prognosis[edit]

The prognosis for patients with a uterine niche varies. Surgical repair can alleviate symptoms and improve fertility outcomes, but the success rate depends on the size and location of the niche.

See also[edit]

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