Incidence of Cesarean Scar Niche After Primary Cesarean Section Repair by Three Different Techniques in Minia Maternity University Hospital – A Prospective Observational Study

Gaber, Hany Gaber; Shawky, Hosam; Ragab, Ahmed Abd-Elfattah; Kotb, Ahmed

doi:10.21608/mjmr.2025.395003.1993

Incidence of Cesarean Scar Niche After Primary Cesarean Section Repair by Three Different Techniques in Minia Maternity University Hospital – A Prospective Observational Study

Articles in Press

Document Type : Original Article

Authors

¹ Obstetric and gynaecology, faculty of medicine, minia university

² Obstetrics and Gynecology, Faculty of Medicine, Minia University, Egypt.

³ Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Egypt

⁴ Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt

10.21608/mjmr.2025.395003.1993

Abstract

Introduction: One common postoperative defect that can lead to, abnormal uterine bleeding, infertility,and pelvic pain is a cesarean scar niche. The process of uterine closure is crucial in the development of niches.

Objective: evaluate and compare the occurrence and features of cesarean scar niches after a primary cesarean section using three different closure methods: single-layer, double layer non locking, and double layer with parallel closure.

Methods: This randomized prospective observational study included 102 women undergoing elective primary cesarean section. Patients were randomized into three groups (n=34 each) based on uterine closure technique. Transvaginal sonography was performed at 3 and 6 months to assess niche presence, depth, residual myometrial thickness (RMT), and related symptoms.

Results: Niche presence was highest in the single layer group (28.4% at 3 months; 41.5% at 6 months) and lowest in the parallel closure group (5.9% and 8.8%, respectively). Technique C (parallel closure) showed significantly less niche depth and higher RMT at both follow-ups. Symptomatic cases were also fewer within the parallel closure group.

Conclusion: Parallel double-layer closure technique significantly reduces niche formation and improves uterine healing compared to other techniques. This technique may be preferable to minimize future gynecologic and obstetric complications.

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