الفهرس 
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Abstract
Cesarean delivery is one of the most common surgical procedures in women, with rates of 50% or more in Egypt. As a result, the rate is rising for cesarean scar defect—the presence of a ―niche‖ at the site of cesarean delivery scar—with the reported prevalence between 24% and 70% in a random population of women with at least one cesarean delivery. Other terms for cesarean scar defect include a niche, isthmocele, uteroperitoneal fistula, and diverticulum.
Transvaginal ultrasonography or saline-infusion sonohysterogram serve as a first-line test for in-office diagnosis. Magnetic resonance imaging (MRI), 3-D ultrasonography, and hysteroscopy are additional useful imaging modalities that can aid in the diagnosis.
This prospective cross-sectional study was conducted at Menoufia University hospitals and Berkt Al sabae Hospital aiming to evaluate endovaginal ultrasound versus hysterosalpingogram in evaluation of uterine scar after cesarean section.
A total of 38 non-pregnant cases (n = 38) were included in the study. All these cases were subjected to transvaginal US and hysterosalpingography.
The mean age of the included cases was 23.36 years (range, 20 – 31 years). As regard the previous pregnancy, the mean gestational age was 37.97 weeks (range, 35 – 40), while fetal weight at birth had a mean value 3261.84 gm (range, 2600 – 4000 gm).
Regarding the uterine position, 23 cases had anteflexed uterus (60.5%), whereas the remaining cases had retroflexed uterus (39.5%).
from all the include cases, uterine scar defect was identified in 21 cases by hysterosalpingography (55.3%), while transvaginal US was able to identify it in only 13 cases (34.2%).
By transvaginal US, the mean distance between the scar and internal os was 4.61 mm (range, 1 – 9 mm). Also, the residual myometrial thickness had a mean value of 8.37 mm (range, 5 – 13 mm). When it comes to scar dimensions, the mean values of its width and depth were 8.92 and 5.29 mm respectively.
There was a significant agreement between hysterosalpingogram and transvaginal ultrasound in the detection of cesarean section scar defect (p < 0.001). Compared to hysterosalpingogram, transvaginal US had sensitivity and specificity of 61.9 and 100% respectively in detecting scar defects, with an accuracy of 78.94%.