Uterine niches following cesarean section: the problem of diagnosis and treatment

DOI

https://dx.doi.org/10.18565/aig.2023.235

Loginova E.A., Valiev R.K., Ivanova L.B., Davydova I.Yu., Dymova A.V.
A.S. Loginov Moscow Clinical Scientific Centre, Moscow Department of Health, Moscow, Russia

Currently, there is an increase in the frequency of cesarean sections, and the number of young fertile women with a scar on the uterus rises as well. The presence of any scar on the uterus is always a risk for reproductive complications. If there is a severe myometrial defect, it can lead to thinning of the myometrium of less than 3 mm and formation of a defect on the part of the uterine cavity (niche). This article discusses the issues of terminology, the causes of formation and the clinical consequences of the defects in the scar area. Uterine rupture along the scar during pregnancy and childbirth is a life-threatening complication that can occur in the absence of timely diagnosis and treatment of this pathology in women planning a pregnancy. Modern algorithms for diagnosis and choice of treatment tactics depending on the clinical and instrumental results of the examination are presented in the article. Ultrasound examination, sonography, MRI, hysteroscopy are the main methods for diagnosing pathology in the area of the uterine scar after cesarean section. Depending on the clinical symptoms, the patient’s reproductive plans and the location of the defect, both dynamic observation and surgical correction of the uterine scar are possible. Hysteroscopic niche resection and metroplasty are the main methods of surgical treatment of patients with uterine scar defects.
Conclusion: The comprehensive examination of women with a uterine scar after cesarean section, the combination of at least two examination methods (ultrasound and MRI) can significantly increase the accuracy and quality of diagnosing the condition of the postoperative uterine scar. The choice of treatment for defects in the area of the uterine scar after cesarean section depends on the severity of clinical symptoms, the woman’s reproductive plans, the characteristics and localization of the myometrial defect in the area of the scar. Reconstructive surgery on the uterus (metroplasty) makes it possible not only to improve the quality of a woman’s life and restore fertility, but most importantly it can reduce the risks of life – threatening complications during pregnancy.

Authors’ contributions: Loginova E.A., Ivanova L.B., Dymova A.V. – developing the concept and design of the study, collecting and processing the material, writing the text; Loginova E.A., Ivanova L.B. – collecting the material; Davydova I.Yu., Valiev R.K., Ivanova L.B. – editing the text.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Loginova E.A., Valiev R.K., Ivanova L.B., Davydova I.Yu.,
Dymova A.V. Uterine niches following cesarean section: the problem of diagnosis and treatment.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (4): 24-32 (in Russian)
https://dx.doi.org/10.18565/aig.2023.235

myometrial defect

niche

cesarean section

metroplasty

laparoscopy

robot-assisted surgery

Full text (in Russian)

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Received 10.10.2023

Accepted 16.04.2024

Ekaterina A. Loginova, PhD, Researcher at the Laboratory of Gynecology, Department of Pelvic Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, 111123, Russia, Moscow, Entuziastov Highway, 86, +7(495)304-30-35, +7(985)182-28-58, e.loginova@mknc.ru,
https://orcid.org/0000-0002-5061-1227
Ramiz K. Valiev, PhD, Head of the Department of Pelvic Floor Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, 111123, Russia, Moscow, Entuziastov Highway, 86, +7(495)304-30-35, r.valiev@mknc.ru
Larisa B. Ivanova, PhD, Head of the Laboratory of Gynecology, Pelvic Oncology Department, A.S. Loginov Moscow Clinical Scientific and Practical Center,
Moscow Healthcare Department, 111123, Russia, Moscow, Entuziastov Highway, 86, +7(495)304-30-35, l.ivanova@mknc.ru
Irina Yu. Davydova, Dr. Med. Sci., Leading Researcher, Department of Pelvic Floor Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center,
Moscow Healthcare Department, 111123, Russia, Moscow, Entuziastov Highway, 86, +7(495)304-30-35, i.davydova@mknc.ru
Alisa V. Dymova, obstetrician-gynecologist at the Department of Oncosurgery of the Pelvic Organs, A.S. Loginov Moscow Clinical Scientific and Practical Center,
Moscow Healthcare Department, 111123, Russia, Moscow, Enthusiastov Highway, 86, +7(495)304-30-35, а.dymova@mknc.ru

Uterine niches following cesarean section: the problem of diagnosis and treatment

Loginova E.A., Valiev R.K., Ivanova L.B., Davydova I.Yu., Dymova A.V.

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