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Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update

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Abstract

Uterine niche is one of the emerging complications of caesarean section. With rising caesarean rates, the caesarean-related iatrogenic complications are also on the rise. These include placenta accreta, scar ectopic pregnancy and uterine niche which is a newer entity being described in the recent literature. Uterine niche, also described as uterine isthmocele, caesarean scar defect and diverticulum, is an iatrogenic defect in the myometrium at the site of previous caesarean scar due to defective tissue healing. Patients may have varied symptoms including abnormal uterine bleeding, post-menstrual spotting and infertility, though many women may be asymptomatic and diagnosed incidentally. Diagnosis is made radiologically by transvaginal sonography, saline instillation sonohysterography or magnetic resonance imaging. Occurrence of niche may be prevented by using correct surgical technique during caesarean. Patients may be managed medically; however, subfertility and persistent symptoms may require surgical correction either by hysteroscopic resection or transabdominal or transvaginal repair. This mini-review comprehensively covers the potential risk factors, clinical presentation, diagnosis and management of this increasingly encountered condition due to rising caesarean rates.

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Acknowledgements

We acknowledge contribution of Dr Vatsla Dadhwal, Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, for providing figures for the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, 3082 A, 3rd Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India

    Vidushi Kulshrestha, Nutan Agarwal & Garima Kachhawa

  2. Department of Obstetrics and Gynaecology, Artemis Hospital, Gurugram, Haryana, India

    Nutan Agarwal

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  1. Vidushi Kulshrestha
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  2. Nutan Agarwal
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  3. Garima Kachhawa
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Correspondence to Vidushi Kulshrestha.

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Vidushi Kulshrestha is a Associate Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India; Nutan Agarwal is a Consultant Gynaecologist, Head- Fetal Medicine, Department of Obstetrics and Gynaecology, Artemis Hospital, Gurugram, Haryana, India; Ex-Professor, Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India; Garima Kachhawa is a Additional Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

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Kulshrestha, V., Agarwal, N. & Kachhawa, G. Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update. J Obstet Gynecol India 70, 440–446 (2020). https://doi.org/10.1007/s13224-020-01370-0

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  • DOI: https://doi.org/10.1007/s13224-020-01370-0

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