Clinical Features:
A 28-year-old female patient with the history of previous two caesarean sections came for a folliculometry with a desire to conceive.
Ultrasound Features:
Semicircular & triangular myometrial defects & tethering of the endometrium are seen in the lower uterine segment at the region of the old cesarean scar.
Remember:
- A niche has been described as the indentation of myometrium of at least 2mm due to tethering of the endometrium.
- Due to tethering of the endometrium, blood accumulates in a niche and may serve as a source of dysfunctional uterine bleeding, accounting for spotting 2-12 days after the routine menstrual cycle.
Ultrasound Diagnosis:
Caesarean Section Scar Niche
Ultrasound Images:
Transabdominal ultrasound showing small anechoic area at the lower uterine segment
Transabdominal ultrasound showing small anechoic area at the lower uterine segment
Transvaginal ultrasound showing a bulky uterus in longitudinal section
Transvaginal ultrasound in transverse section
Transvaginal ultrasound in longitudinal section showing semicircular myometrial defect & tethering of the endometrium in the lower uterine segment at the region of the old cesarean scar.
Proximal anterior myometrial narrowing
Distal anterior myometrial narrowing
Semicircular & triangular myometrial defects & tethering of the endometrium in the lower uterine segment at the regions of the old cesarean scars.
Mild endometrial collection
Niche in transverse section
Measurement technique of a niche
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