Prevalence and Risk Factors of Cesarean Section Scar Niche at King Hamad University Hospital (KHUH)
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Abstract
Background: Cesarean scar defects (CSD), or niche, are a recognized complication of cesarean sections, with reported prevalence ranging from 24% - 70%. While often asymptomatic, CSD can cause postmenstrual bleeding, infertility, dysmennorhea, abdominal pain, obstetric risks like uterine rupture, and placenta accreta. Risk factors include technique and closure of hysterotomy incision, multiple CS, and uterine position, though evidence remains inconsistent. Despite a rising global CS rate, regional data on CSD prevalence and predictors are limited. This study evaluates CSD frequency and associated factors in a clinical cohort to guide in identifying risk factors, prevention, and management strategies.
Methods: A prospective study was conducted on 111 women who delivered via CS. Demographic, clinical, and surgical data were collected, and CSD was assessed via ultrasound. Statistical analysis was performed using IBM SPSS version 20.0, employing Chi-square, Student t-test, and Mann-Whitney tests as appropriate.
Results: The prevalence of CSD was 9% (10/111). The mean residual myometrial thickness in affected women was 6.50 ± 7.75 mm (median: 3.5 mm). No significant associations were found between CSD and age (p = 0.785), BMI (p = 0.287), parity (p = 1.000), or diabetes (p = 1.000). However, women with ≥2 previous CS showed a non-significant trend toward higher CSD rates (40% vs. 15.8%, p = 0.210). Notably, retroverted uterus (RVF) was more common in the CSD group (30% vs. 8.9%, p = 0.075). Surgical factors, including double-layer closure and Vicryl sutures (100% of cases), and locking sutures and the first layer of the uterus, did not influence CSD development.
Conclusion: The prevalence of CSD in this cohort was lower than global estimates, with no significant demographic or surgical risk factors identified. The trend toward higher CSD rates in women with multiple CS and RVF warrants further investigation. These findings underscore the need for standardized surgical techniques and long-term monitoring to mitigate CSD-related morbidity.
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