Symptomatic niches in the uterine scar after cesarean section: analysis of the causes of development and clinical manifestations

M.T. Torobaeva, S.N. Buyanova, S.A. Petrakova
In: Russian Journal of Human Reproduction · 2025 · vol. 31(4) , pp. 110 · doi:10.17116/repro202531041110 · W4414130380
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This study identified adenomyosis, prolonged labor, emergency cesarean section, and specific surgical techniques as significant risk factors for developing symptomatic uterine scar niches following cesarean delivery.

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This narrative review analyzes the etiology and clinical manifestations of symptomatic niches, also known as isthmoceles or cesarean scar defects, within the uterine wall following cesarean section. The authors synthesize existing literature to define prevalence, diagnostic criteria, and treatment options for conditions such as postmenstrual spotting, chronic pelvic pain, and secondary infertility associated with these structural abnormalities. While the text primarily focuses on the surgical and medical management of cesarean scar defects, it briefly acknowledges a potential association with endometriosis in one cited reference regarding the co-occurrence of isthmocele and endometriotic lesions. This paper is not centrally about endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Objective. Identification of the most significant reasons for the development of symptomatic niches. Material and methods. In the course of the study, two groups were formed: the main and the control. The main group consisted of 2 subgroups: Ia subgroup — 58 patients with clinical manifestations of insolvent scar on the uterus after CC and the thickness of retained myometry 2 mm Ib — 48 patients with insolvent scar on the uterus and the thickness of retained myometry 2 mm, but without symptoms. In order to identify the causes of the development of an insolvent scar on the uterus, a control group was created — patients (n=32) with a scar on the uterus after a caesarean section. Results. The causes of the development of large symptomatic niches (an incompetent scar on the uterus) are: the course of pregnancy complicated by exacerbation of bronchopulmonary diseases (HR=2.53; 95% CI: 1.096—5.867) and genitourinary systems (HR=4.07; 95% CI: 1.024—16.214); anhydrous interval ≥12 hours (HR=10.2; 95% CI: 1.462—72.066); emergency CS (HR=2.19, 95% CI: 1.344—3.587); incision on the uterus repaired with a single-row suture (HR=2.6; 95% CI: 1.016—6.871); intrauterine interventions in the early postoperative period (HR=7.2; 95% CI: 1.020—51.486); adenomyosis (p<0.05), duration of labor for ≥6 hours (HR=2.7; 95% CI:1.206—6.395). Conclusion. Symptomatic scar niches on the uterus after a large cesarean section are a multifactorial disease. Symptoms of an untenable scar on the uterus can begin to bother patients as early as 6 months to 5 years after CS, averaging 2.3±0.4 years and have various clinical manifestations.
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Сайт издательства «Медиа Сфера» содержит материалы, предназначенные исключительно для работников здравоохранения. Закрывая это сообщение, Вы подтверждаете, что являетесь дипломированным медицинским работником или студентом медицинского образовательного учреждения. Результаты поиска: 0 Симптоматические ниши больших размеров в рубце на матке после кесарева сечения (несостоятельный рубец на матке): анализ причин развития и клинических проявлений Журнал: Проблемы репродукции. 2025;31(4): 110‑115 Прочитано: 861 раз Как цитировать: Литература / References: - Tsuji S, Nobuta Y, Hanada T, Takebayashi A, Inatomi A, Takahashi A, Amano T, Murakami T. Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review. Reproductive Medicine and Biology. 2023;22(1):e12532. https://doi.org/10.1002/rmb2.12532 - Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. Journal of Minimally Invasive Gynecology. 2016;23(6):893-902. https://doi.org/10.1016/j.jmig.2016.06.020 - Casadio P, Raffone A, Alletto A, Filipponi F, Raimondo D, Arena A, La Rosa M, Virgilio A, Franceschini C, Gubbini G, Franchini M, Paradisi R, Lenzi J, Travaglino A, Mollo A, Carugno J, Seracchioli R. Postoperative morphologic changes of the isthmocele and clinical impact in patients treated by channel-like (360°) hysteroscopic technique. International Journal of Gynecology and Obstetrics. 2023;160(1):326-333. https://doi.org/10.1002/ijgo.14387 - Karampelas S, Salem Wehbe G, de Landsheere L, Badr DA, Tebache L, Nisolle M. Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section. Journal of Clinical Medicine. 2021;10(24):5785. https://doi.org/10.3390/jcm10245785 - Zhang J, Zhu C, Yan L, Wang Y, Zhu Q, He C, He X, Ji S, Tian Y, Xie L, Liang Y, Xia W, Mol BW, Huirne JAF. Comparing levonorgestrel intrauterine system with hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine cesarean scar: a randomized, open-label, controlled trial. American Journal of Obstetrics and Gynecology. 2023;228(6):712.e1-712.e16. https://doi.org/10.1016/j.ajog.2023.03.020 - Вученович Ю.Д., Новикова В.А., Радзинский В.Е. Успех попытки родов через естественные родовые пути после двух кесаревых сечений. Каковы шансы? Российский вестник акушера-гинеколога. 2020;20(5):61-67. - Zheng X, Yan J, Liu Z, Wang X, Xu R, Li L, Lin Z, Zheng L, Liu M, Chen Y. Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum. Journal of International Medical Research. 2020;48(9):300060520954993. https://doi.org/10.1177/0300060520954993 - Zhang NN, Wang GW, Zuo N, Yang Q. Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection. BMC Pregnancy Childbirth. 2021;21(1):815. https://doi.org/10.1186/s12884-021-04281-8 - Pešková V, Kacerovský M. Cesarean scar defect — manifestation, diagnostics, treatment. Ceska Gynekol. 2020;85(4):282-287. - Shi H, He J, Gao Y, Qin S, Fan J, Xiao Q, Li K, Liang H. Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study. BMC Women’s Health. 2020;20(1):75. https://doi.org/10.1186/s12905-020-00928-4 - Vitagliano A, Cicinelli E, Viganò P, Sorgente G, Nicolì P, Busnelli A, Dellino M, Damiani GR, Gerli S, Favilli A. Isthmocele, not cesarean section per se, reduces in vitro fertilization success: a systematic review and meta-analysis of over 10,000 embryo transfer cycles. Fertility and Sterility. 2023;10:S0015-0282(23)01996-9. https://doi.org/10.1016/j.fertnstert.2023.11.007 - Tanimura S, Funamoto H, Hosono T, Shitano Y, Nakashima M, Ametani Y, Nakano T. New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect. The Journal of Obstetrics and Gynaecology Research. 2015;41(9):1363-1369. https://doi.org/10.1111/jog.12738 - Stegwee SI, Beij A, de Leeuw RA, Mokkink LB, van der Voet LF, Huirne JAF. Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature. Qual Life Res. 2020;29(4):1013-1025. https://doi.org/10.1007/s11136-019-02376-6 - Nezhat C, Zaghi B, Baek K, Nezhat A, Nezhat F, Lindheim S, Nezhat C. Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study. Journal of Clinical Medicine. 2023;12(11):3720. https://doi.org/10.3390/jcm12113720 - Glenn TL, Han E. Cesarean scar defect: far from understood. Fertility and Sterility. 2021;116(2):369-370. https://doi.org/10.1016/j.fertnstert.2021.06.006 - Gulz M, Imboden S, Nirgianakis K, Siegenthaler F, Rau TT, Mueller MD. Endometriosis and Isthmocele: Common or Rare? Journal of Clinical Medicine. 2022;11(5):1158. https://doi.org/10.3390/jcm11051158 - Xia W, Sun T, Wang Y, Tian Y, Li Y, Liang Y, He C, Zhang J, Huang H. A morphological study of symptomatic uterine niche using three-dimensional models from thin-slice magnetic resonance imaging. Reproductive BioMedicine Online. 2024 Apr;48(4):103683. https://doi.org/10.1016/j.rbmo.2023.103683 Подтверждение e-mail На [email protected] отправлено письмо со ссылкой для подтверждения e-mail. Перейдите по ссылке из письма, чтобы завершить регистрацию на сайте. Подтверждение e-mail Мы используем файлы cооkies для улучшения работы сайта. Оставаясь на нашем сайте, вы соглашаетесь с условиями использования файлов cооkies. 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