Gynaecological morbidity associated with caesarean niche: increasing awareness, prevention and management

• DOI: 10.1111/tog.12642
• Publication Date: 2019-12-21T09:05:30Z
• Authors: Adam J Brook; Fiona R Clarke; Kalsang Bhatia
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Key content

Caesarean section rates are rising globally; while obstetric consequences are well defined, long‐term gynaecological sequelae are frequently overlooked. Caesarean niche results from poor healing of the uterine scar and is being increasingly reported as an important factor in a variety of new gynaecological symptoms reported after caesarean section. Until recently, a lack of high‐quality evidence has hampered diagnostic assessment. Recent publications provide a useful consensus for improved diagnosis and guidance on management, with thoughts that caesarean section technique potentially contributes to niche development.

Learning objectives

To describe the gynaecological morbidity associated with caesarean niche. To understand theories regarding caesarean niche development, its sonographic assessment for clinical relevance and subsequent management. To reflect on surgical techniques for caesarean section to minimise niche development.

Ethical issues

With rising caesarean section rates, caesarean niche is an emerging clinical problem. Should we advise women of the possibility of long‐term gynaecological consequences of the caesarean niche?