Gynaecological morbidity associated with caesarean niche: increasing awareness, prevention and management
Author(s) Brook A.J.; Clarke F.R.; Bhatia K.
Source Obstetrician and Gynaecologist; Apr 2020; vol. 22 (no. 2); p. 122-130
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?
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