• Caesarean section: long-term consequences – «niches» of postoperative scar
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Caesarean section: long-term consequences – «niches» of postoperative scar

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.1(73):54-56; doi 10.15574/PP.2018.73.54

Ohorodnik A. O., Davydova Yu. V., Butenko L. P.
SI «Institute of Pediatrics, Obstetrics and Gynaecology of NAMS of Ukraine», Kyiv, Ukraine

In view of the unceasing growth of operative labor, clinicians and scientists are faced with the issue of the caesarean section (CS) safety. In addition, its further influence on the quality of life, fertility and menstrual function of a woman is not fully understood. Taking into account the above, an analysis of existing literature data on one of the possible complications of postoperative scarring, so-called «niches», has been carried out. It is important to find out the aetiology of niche development after CS in order to develop preventive strategies and identify the most effective treatment methods.
Key words: Caesarean section, niche, scar, uterus, cervix, uterine bleeding, spotting.


1. Abalos E, Addo V, Brocklehurst P, El SM, Farrell B, Gray S, Hardy P, Juszczak E, Mathews JE, Masood SN et al. (2013). Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial. Lancet.382:234—248. https://doi.org/10.1016/S0140-6736(13)60441-9

2. Awonuga AO, Fletcher NM, Saed GM, Diamond MP.(2011). Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci.18:1166—1185. https://doi.org/10.1177/1933719111414206; PMid:21775773 PMCid:PMC3343100

3. Barros AJ, Santos IS, Matijasevich A, Domingues MR, Silveira M, Barros FC, Victora CG.(2011). Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica.45:635—643. https://doi.org/10.1590/S0034-89102011005000039; PMid:21670862 PMCid:PMC3794425

4. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van LP, Wagner M. 2007.Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol.21:98—113. https://doi.org/10.1111/j.1365-3016.2007.00786.x; PMid:17302638

5. Bij de Vaate AJ, Brolmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. (2011). Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 37:93—99. https://doi.org/10.1002/uog.8864; PMid:21031351

6. Bij de Vaate AJ, van der Voet LF, Naji O, Witmer M, Veersema S, Brolmann HA, Bourne T, Huirne JA. (2014). Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol.43:372—382. https://doi.org/10.1002/uog.13199; PMid:23996650

7. Buhimschi CS, Zhao G, Sora N, Madri JA, Buhimschi IA.(2010).Myometrial wound healing post-Cesarean delivery in the MRL/MpJ mouse model of uterine scarring.Am J Pathol.177:197—207. https://doi.org/10.2353/ajpath.2010.091209; PMid:20489145 PMCid:PMC2893663

8. Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. (2002).The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol.186:1326—1330. https://doi.org/10.1067/mob.2002.122416; PMid:12066117

9. Bujold E, Goyet M, Marcoux S, Brassard N, Cormier B, Hamilton E, Abdous B, Sidi EA, Kinch R, Miner L et al. (2010). The role of uterine closure in the risk of uterine rupture.Obstet Gynecol.116:43—50. https://doi.org/10.1097/AOG.0b013e3181e41be3; https://doi.org/10.1097/AOG.0b013e3181f4c99e; https://doi.org/10.1097/AOG.0b013e3181f4d9b2; PMid:20567166

10. Caesarean section surgical techniques: a randomised factorial trial (CAESAR).(2010). BJOG.117:1366—1376.

11. Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH. (2013). Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod. 28:1943—1952. https://doi.org/10.1093/humrep/det130; PMid:23644593

12. Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK., Brolmann HAM, Mol BWJ, Huirne JAF (2015). Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development Hum Reprod. 30(12):2695—2702. https://doi.org/10.1093/humrep/dev240