CS scar niche.
- 1. CS SCAR NICHE (DEFECT) BY MAGDY ABDELRAHMAN MOHAMED LECTURER OF OB/GYN 2017
- 3. •Increase rate of CS lead to: •Dehiscent scar & rupture uterus. •Morbidly adherent placenta. •CS scar niche.
- 4. DEFINITION • No consensus. • Indentations of the myometrium of at least 2 mm.
- 5. DEFINITION • Large niche was defined as depth at least 50% of the anterior myometrium, or the remaining myometrial thickness ≤2.2 mm by TVS or ≤2.5 mm by sonohysterography. • Van Der Voet et al., 2014.
- 6. ETIOLOGY • Low (cervical) location of the uterine incision during a CS. • Incomplete closure of the uterine wall, due to single-layer, endometrial saving closure technique. • Surgical activities that may induce adhesion formation (i.e. nonclosure of peritoneum, inadequate haemostasis.) • Patient related factor. (poor healing)
- 7. GYNECOLOGICAL SYMPTOMS •Postmenstrual spotting. •Dysmenorrhea. •Chronic pelvic pain. •Dyspareunia.
- 8. REPRODUCTIVE EFFECT • Subfertility.? Retained menstrual blood within niche may lead to: • Chronic inflammatory state. • Impair sperm motility. • Impair implantation. • CS scar pregnancy. • Scar dehiscence in future pregnancy.
- 9. DIAGNOSIS No consensus for accurate diagnosis. •TVS…. Better during menses or bleeding. •Saline infusion sonohysterography. •HSG. •Hysteroscopy.
- 12. TREATMENT OPTIONS •Medical therapy (symptomatic ttt). • Analgesic, COCs. •Surgical correction. • Hysteroscopic niche resection. • Laparoscopic repair. • Vaginal repair.