Changes in the Uterine Scar during the First Year after a Caesarean Section: A Prospective Longitudinal Study: A Prospective Longitudinal Study

Lucy F. van der Voet, Inge P. M. Jordans, Hans A. M. Brölmann, Sebastiaan Veersema, Judith A. F. Huirne

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Aim: To study changes in a ceasarean section (CS) scar during the first year after a CS using gel installation sonography (GIS). Methods: Proof-of-concept study, prospective cohort study. Twenty women who delivered by their first CS were evaluated by both transvaginal sonography and GIS 2 months and 1 year after CS. A niche was defined as an anechogenic space at the uterine caesarean scar with a depth >2 mm. The primary outcome was any change in the thickness of the residual myometrium (RMT) as evaluated by GIS. Results: Mean RMT changed in time from 11.9 mm at 2 months to 6.5 mm at 12 months after the CS (p < 0.001). Niche prevalence did not change. The adjacent myometrium (AM) reduced from 15 to 12.4 mm (p = 0.04). The ratio between RMT and AM with GIS decreased from 0.80 at 2 months to 0.54 at 12 months (p = 0.002). Conclusion: RMT thickness, the adjacent myometium and the ratio between the RMT and AM reduces from 2 to 12 months after a CS. The prevalence did not change. This needs to be taken into account when deciding on the timing of niche measurement and the interpretation of the RMT.
Original languageEnglish
Pages (from-to)164-170
Number of pages7
JournalGynecologic and Obstetric Investigation
Issue number2
Publication statusPublished - 1 Mar 2018


  • Caesarean section scar
  • Niche
  • Sonohysterography
  • Ultrasound

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