What is a caesarean niche?
A defect in the lower uterine scar can be present in up to 80% of all caesarean sections. A percentage of these can lead to long term problems. Other terms used are caesarean scar disorder/syndrome and isthmocele. The problem is increasing worldwide due to an increase in the rates of caesarean section.
What problems are associated with a caesarean niche?
A proportion may experience infertility, menstrual dysfunction and chronic pain.
What symptoms are experienced with a problematic caesarean niche?
Patients may report postmenstrual spotting, prolonged menstruation and fluid in uterine cavity may be present around day 21 of the menstrual cycle.
How does a caesarean niche cause infertility?
Caesarean scar defects may contain fluid and blood which can lead to impaired sperm receptivity and implantation of the embryo.
Can problematic caesarean niches be repaired?
Yes, these can be repaired via a conservative hysteroscopic method or by laparoscopy (keyhole surgery). The laparoscopic route involves a resection of the caesarean scar and creating a new one.
How to minimise the chance of developing a caesarean niche?
Ensure that a caesarean section is being undertaken for the right reasons and a good surgical technique by the doctor should minimise the risk.