CS scar niche.

CS scar niche.

• 1.
  CS SCAR NICHE (DEFECT) BY MAGDYABDELRAHMAN MOHAMED LECTURER OF OB/GYN 2017
• 2.
  NOMENCLATURE •Niche. •Defect. •Diverticulum. •Pouch.
• 3.
  •Increase rate ofCS lead to: •Dehiscent scar & rupture uterus. •Morbidly adherent placenta. •CS scar niche.
• 4.
  DEFINITION • No consensus. •Indentations of the myometrium of at least 2 mm.
• 5.
  DEFINITION • Large nichewas defined as depth at least 50% of the anterior myometrium, or the remaining myometrial thickness ≤2.2 mm by TVS or ≤2.5 mm by sonohysterography. • Van Der Voet et al., 2014.
• 6.
  ETIOLOGY • Low (cervical)location of the uterine incision during a CS. • Incomplete closure of the uterine wall, due to single-layer, endometrial saving closure technique. • Surgical activities that may induce adhesion formation (i.e. nonclosure of peritoneum, inadequate haemostasis.) • Patient related factor. (poor healing)
• 7.
  GYNECOLOGICAL SYMPTOMS •Postmenstrual spotting. •Dysmenorrhea. •Chronicpelvic pain. •Dyspareunia.
• 8.
  REPRODUCTIVE EFFECT • Subfertility.? Retainedmenstrual blood within niche may lead to: • Chronic inflammatory state. • Impair sperm motility. • Impair implantation. • CS scar pregnancy. • Scar dehiscence in future pregnancy.
• 9.
  DIAGNOSIS No consensus foraccurate diagnosis. •TVS…. Better during menses or bleeding. •Saline infusion sonohysterography. •HSG. •Hysteroscopy.
• 12.
  TREATMENT OPTIONS •Medical therapy(symptomatic ttt). • Analgesic, COCs. •Surgical correction. • Hysteroscopic niche resection. • Laparoscopic repair. • Vaginal repair.