PREVALENCE OF CAESAREAN SECTION NICHE IN WOMEN WITH PREVIOUS CAESAREAN SECTION AND ITS EFFECT ON REPRODUCTIVE HEALTH

Volume 13 , Issue 4 , July 2025 , Pages 443-454

Authors

Gona Aziz Rahim 1

1 Chwarbakh Health Center, Ministry of Health Sulaymaniyah, Kurdistan Region, Iraq.

DOI logo 10.17656/jsmc.10439

Keywords

Abstract

Background
The Cesarean Section (CS) rate has been increasing in recent practice worldwide as well as in Iraq, and there
are many gynecological and obstetric problems related to CS also increasing in parallel to CS, some of them
may be related to cesarean scar niche (CSN). There has yet to be a consensus about the gold standard method
for diagnosing CSN, its prevalence, and the symptoms it causes.
Objective
This study aims to fi nd the prevalence of CSN in women with previous CS and how common gynaecological
symptoms, including abnormal uterine bleeding, are among women who have had cesarean section niches
compared to women with no CSN.
Patients and Methods
This is a cross-sectional study conducted in private clinics of gynaecology and ultrasonography in Sulaymaniyah/
Kurdistan/Iraq from December 2020 to May 2023. It involved 259 women with a history of previous Cesarean
section for whom transvaginal ultrasound was done to fi nd the presence or absence of CSN. Accordingly, they
divided into two groups: the fi rst with CSN and the second with no CSN. Both groups followed prospectively
for several parameters: postmenstrual spotting, intermenstrual bleeding, dysmenorrhea, dyspareunia, chronic
pelvic pain, and subfertility—the chi-square test used for statistical analysis of the variables.
Results
This study was carried out on 259 women with a history of one or more CS. Diagnosis of CSN done by 2D
TVU: 44% of them had CSN, and 66% had no CSN; the prevalence of CSN was higher in women with repeated
CS (P˂0.001). Not all scar niches had symptoms but were frequently symptomatic; in this group, 50.9% were
symptomatic, while in those with no CSN, 26.2% were symptomatic (P˂0.001). Postmenstrual spotting and
dysmenorrhea were the most predominant symptoms, which were statistically signifi cant compared to the
group of no niche (P P˂0.001). At the same time, dyspareunia, chronic pelvic pain, and subfertility were not
signifi cantly increased. In the group of CSN, 44.73% had large, and 55.26% had small niches. Postmenstrual
spotting and dysmenorrhea symptoms were more prevalent in women with large CSN than in small CSN
(P˂0.001).
Conclusion
The prevalence of cesarean scar niche was 44% in women with previous CS, which can cause postmenstrual
spotting and dysmenorrhea. More studies need to be addressed regarding intermenstrual bleeding, dyspareunia,
chronic pelvic pain, and subfertility. Therefore, the practice of cesarean section on request is not recommended.

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  • First online26 July 2025
  • Published at26 July 2025

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