Tahermanesh Kobra, Allahqoli Leila, Karimzadeh Atieh, Nasiri Zeidi Setare, Shahriyaripour Roya, Hanjani Soheil, Ghafourian Norouzi Shima, Bozorgmehr Behnoosh, Moghadam Arnoush Rahnama, Amanollahi Alireza, Anvari-Yazdi Abbas Fazel, Alkatout Ibrahim
Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Ministry of Health and Medical Education, Tehran, Iran.
Am J Obstet Gynecol. 2025 Apr;232(4):373.e1-373.e10. doi: 10.1016/j.ajog.2024.10.010. Epub 2024 Oct 17.
The cesarean scar niche, a consequence of incomplete wound healing, can lead to gynecological complications and affect future pregnancies. While internal niches have been well-studied, external and bidirectional niches are also important.
We aimed to conduct a comparative analysis of the prevalence and measurements of different types of niches.
This cross-sectional study examined 200 patients with prior cesarean delivery undergoing hysterectomy due to abnormal uterine bleeding. It evaluated internal, external, and bidirectional niche prevalence, measurements (height, residual myometrial thickness, and adjacent myometrial thickness), and classification in hysterectomy specimens compared to prehysterectomy transvaginal sonography reports. The secondary outcome was to determine niche presence in uterine tissue samples based on the number of previous cesarean deliveries.
The mean age of the study participants was 48.19 years, with 30% having undergone only one cesarean delivery. Notably, 83.5% had niches detected via sonography, while 91% had niches identified in uterine tissue samples posthysterectomy (P value=.008). Internal niches were common, with significant associations between niche presence and the number of previous cesarean deliveries. 23.3% of patients with one cesarean delivery had internal niches. Additionally, external niches were detected in 4% of hysterectomy samples but not observed in ultrasound reports. Key parameters such as residual myometrium thickness and adjacent myometrial thickness differed notably between ultrasound and tissue samples, highlighting discrepancies in niche detection methods. Residual myometrium thickness ranged from 2.8 to 24 mm (7.68±3.09 mm) in ultrasound reports vs 0 to 25 mm (4.28±2.71 mm) in tissue samples (P<.001). Adjacent myometrial thickness ranged from 6 to 29 mm (17.08±4.53 mm) in ultrasound reports vs 7.5 to 30 mm (16±5.03 mm) in tissue samples (P<.001). This study underscores the importance of accurate niche assessment in patients with prior cesarean delivery.
We performed a comparative analysis of niche prevalence and measurements in gross specimens and transvaginal sonography reports. The results highlight the importance of considering external and bidirectional niches, in addition to internal niches. These niches can reduce residual myometrial thickness and increase future pregnancy complications. Furthermore, we demonstrated that niche formation can occur after a single cesarean delivery.
剖宫产瘢痕憩室是伤口愈合不完全的结果，可导致妇科并发症并影响未来妊娠。虽然内部憩室已得到充分研究，但外部和双向憩室也很重要。
我们旨在对不同类型憩室的患病率和测量值进行比较分析。
这项横断面研究检查了200例因异常子宫出血而接受子宫切除术的既往有剖宫产史的患者。它评估了内部、外部和双向憩室的患病率、测量值（高度、残余肌层厚度和相邻肌层厚度），并将子宫切除标本中的分类与子宫切除术前经阴道超声报告进行比较。次要结果是根据既往剖宫产次数确定子宫组织样本中憩室的存在情况。
研究参与者的平均年龄为48.19岁，30%的人仅接受过一次剖宫产。值得注意的是，83.5%的患者通过超声检测到憩室，而91%的患者在子宫切除术后的子宫组织样本中发现了憩室（P值=0.008）。内部憩室很常见，憩室的存在与既往剖宫产次数之间存在显著关联。23.3%接受过一次剖宫产的患者有内部憩室。此外，在4%的子宫切除样本中检测到外部憩室，但在超声报告中未观察到。超声和组织样本之间，残余肌层厚度和相邻肌层厚度等关键参数存在显著差异，突出了憩室检测方法的差异。超声报告中残余肌层厚度范围为2.8至24毫米（7.68±3.09毫米），而组织样本中为0至25毫米（4.28±2.71毫米）（P<0.001）。超声报告中相邻肌层厚度范围为6至29毫米（17.08±4.53毫米），而组织样本中为7.5至30毫米（16±5.03毫米）（P<0.001）。这项研究强调了对既往有剖宫产史患者进行准确憩室评估的重要性。
我们对大体标本和经阴道超声报告中的憩室患病率和测量值进行了比较分析。结果强调了除内部憩室外，还应考虑外部和双向憩室的重要性。这些憩室可减少残余肌层厚度并增加未来妊娠并发症。此外，我们证明了单次剖宫产术后也可发生憩室形成。
