Cesarean scar niche, fertility and uterine rupture during labor – A retrospective study

• Published in: European journal of obstetrics & gynecology and reproductive biology 2023-07, Vol.286, p.107-111
• Main Authors: Cohen, Nadav, Arush, Lior, Younes, Grace, Lavie, Ofer, Goldberg, Yael
• Format: Article
• Language: English
• Subjects: Case-Control Studies; Cesarean delivery; Cesarean scar defect; Cicatrix - complications; Cicatrix - diagnostic imaging; Female; Fertility; Humans; Pregnancy; Retrospective Studies; Trial of Labor; Ultrasound; Uterine niche; Uterine rupture; Uterine Rupture - etiology; Vaginal Birth after Cesarean - adverse effects
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2023.05.011

•A uterus after a cesarean delivery may have a myometrial scarring, known as niche.•Niches are reported as the most common long-term complication, following cesarean deliveries.•In patients with secondary infertility, cesarean niche doesn’t seem to affect future fertility.•Patients with a known niche, considering trial of vaginal delivery, might be in high-risk group for uterine rupture. To determine how does a uterine niche diagnosed prior to conception, affects future fertility and obstetrical outcomes, in a group of patients with secondary infertility undergoing fertility treatments. A retrospective case-control study was performed, recruiting patients after cesarean delivery, before fertility treatment. Using stored ultrasound photos and video loops, we determined niche's sonographic parameters during the preconception period and retrieved the fertility and obstetrical outcomes thereafter. 104 patients met the inclusion criteria, and 86 were available for analysis. 56 (65%) had uterine niches larger than 2 mm in depth, and 30 (34%) had a uterine scar of 2 mm or less. Demographic characteristics were not different between groups. No statistically significant differences were observed regarding rates of implantation and clinical pregnancy between the groups. There were four cases of cesarean scar rupture during failed trial of labor (TOLAC), all of which were in the group with larger than 2 mm niche (33% of all TOLAC cases in the respected group). While it appears that pre-conception presence of uterine niches larger than 2 mm in depth does not adversely affect future fertility, these niches might serve as a risk factor for future uterine rupture during TOLAC.