Uterine niche

Uterine Niche

Diagram of a uterine niche

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

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

Patients with a uterine niche may present with:

• Abnormal uterine bleeding, particularly postmenstrual spotting
• Pelvic pain
• Dysmenorrhea
• Dyspareunia
• Secondary infertility

Diagnosis

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

• Transvaginal ultrasound
• Sonohysterography
• 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.

Related Pages

• Cesarean section
• Myometrium
• Endometrium
• Infertility