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Research paper
Published online: 2021-03-17
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Two- and three-dimensional transvaginal ultrasound in assessment of the impact of selected obstetric risk factors on cesarean scar niche formation: the case-controlled study

Joanna Budny-Winska, Aleksandra Zimmer-Stelmach, Michal Pomorski
DOI: 10.5603/GP.a2021.0024
·
Pubmed: 33757154

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2021-03-17

Abstract

Objectives: Incomplete healing of the uterine scar after cesarean section may result in formation of a niche. The aim of this
study is to identify the potential risk factors for the improper uterine healing after cesarean section in women with single
layer, full thickness uterine closure with the use of two- and three-dimensional transvaginal ultrasonography.
Material and methods: 204 women with a history of at least one low transverse cesarean section (CS) with a single layer
uterine closure participated in the study. Residual myometrial thickness (RMT), adjacent myometrial thickness (AMT),
width (W), depth (D) and volume of the niche, RMT/AMT, RMT/D, RMT/W ratio and clinical characteristics were analyzed.
Results: A niche after cesarean section was found in 153 cases. However only five patients had a RMT < 2.2 mm, and 35 had
an RMT/AMT ratio ≤ 0.5. The RMT and RMT/AMT ratio among women who had undergone more than one cesarean section
was lower than among women who underwent the first cesarean section. No statistically significant relationship was found
between the incidence of niche, its parameters and cervical dilation, uterine contractions, cesarean section in the second
stage of labor, type of uterus incision expansion and flexion, operator’s experience.
Conclusions: Healing of the uterine cesarean section scar in women with single-layer continuous suture covering the entire
thickness of the myometrium, excluding the decidua is not affected by the mode of caesarean section, type of uterine
incision expansion and flexion, operator’s experience, stage of labor at the time of caesarean section.

Abstract

Objectives: Incomplete healing of the uterine scar after cesarean section may result in formation of a niche. The aim of this
study is to identify the potential risk factors for the improper uterine healing after cesarean section in women with single
layer, full thickness uterine closure with the use of two- and three-dimensional transvaginal ultrasonography.
Material and methods: 204 women with a history of at least one low transverse cesarean section (CS) with a single layer
uterine closure participated in the study. Residual myometrial thickness (RMT), adjacent myometrial thickness (AMT),
width (W), depth (D) and volume of the niche, RMT/AMT, RMT/D, RMT/W ratio and clinical characteristics were analyzed.
Results: A niche after cesarean section was found in 153 cases. However only five patients had a RMT < 2.2 mm, and 35 had
an RMT/AMT ratio ≤ 0.5. The RMT and RMT/AMT ratio among women who had undergone more than one cesarean section
was lower than among women who underwent the first cesarean section. No statistically significant relationship was found
between the incidence of niche, its parameters and cervical dilation, uterine contractions, cesarean section in the second
stage of labor, type of uterus incision expansion and flexion, operator’s experience.
Conclusions: Healing of the uterine cesarean section scar in women with single-layer continuous suture covering the entire
thickness of the myometrium, excluding the decidua is not affected by the mode of caesarean section, type of uterine
incision expansion and flexion, operator’s experience, stage of labor at the time of caesarean section.

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Keywords

cesarean section; scar niche; single layer suture; 3D ultrasonography; VOCAL; risk factors

About this article
Title

Two- and three-dimensional transvaginal ultrasound in assessment of the impact of selected obstetric risk factors on cesarean scar niche formation: the case-controlled study

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-03-17

DOI

10.5603/GP.a2021.0024

Pubmed

33757154

Keywords

cesarean section
scar niche
single layer suture
3D ultrasonography
VOCAL
risk factors

Authors

Joanna Budny-Winska
Aleksandra Zimmer-Stelmach
Michal Pomorski

References (14)
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