الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Over the past two decades, the rates of cesarean section (CS) have been rising globally, in both developed and developing countries.
Latest available data shows that one in three women in the United States (Hamilton et al., 2017; Betran et al., 2021) and up to four in five women in some other places in the world gave birth by CS (Nakamura et al., 2016).
The proportion of cesarean sections in Egypt has been increasing steadily in recent years and has reached an alarming level. The proportion of CS documented in the Egyptian Demographic and Health Survey (EDHS) conducted in 2014 reached more than 60% that quadrupled the maximum threshold recommended by the World Health Organization (WHO) (15%) (Al Rifai 2017).
The rapid increase in cesarean birth rates without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Cesarean section is a vital procedure if performed for the correct reasons. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation and suspected fetal macrosomia (Antila et al., 2018)
This remarkable increase in CS rates has raised the interest in studying the complications of CS delivery. The most frequent early complications are infections (such as endometritis, surgical wound infections and abscesses) and hemorrhages (Rodgers et al., 2012).
Cesarean section, especially repeated CS, is associated with an increased risk for uterine rupture, abnormal placental implantation, placental abruption and uterine scar dehiscence in subsequent pregnancies (Vikhareva osser et al., 2010).
We became aware of gynecological symptoms after a CS, such as postmenstrual spotting, dysmenorrhea, chronic pelvic pain and dyspareunia (Wang et al., 2009; Bij de Vaate et al., 2011 and van der Voet et al., 2014).
The first publications on CS scar defects in relation to bleeding symptoms date from 1975 (Stewart and Evans, 1975).
Patients with abnormal uterine bleeding (AUB) who had undergone prior cesarean sections, specially post menstrual spotting may be due to scar defects left in the uterus by the surgery, forming a diverticulum, an anomaly called Isthmocele or cesarean scar syndrome (Morris, 1995).
And in 1999, Thurmond et al. postulated the hypothesis that a niche in the Cesarean scar could be a cause of abnormal bleeding due to the collection of menstrual blood in a uterine scar defect causing postmenstrual spotting (Thurmond et al., 1999).
However, the relation of such defects with gynecological symptoms in non-pregnant state such as postmenstrual bleeding has only recently been proven in prospective cohort studies in an unselected population of women with a history of CS (Bij de Vaate et al., 2011). Since then the number of publications describing CS scar defects is increasing.
Various imaging methods including ultrasonography, sonohysterography (SHG), hysterography, hysteroscopy and magnetic resonance imaging (MRI) can be used to assess the anterior uterine wall and diagnose uterine niche (Marotta et al., 2013).
Several surgical interventions to treat niche related symptoms have been developed in recent years including laparoscopic surgery, hysteroscopic surgery, laparoscopy – assisted hysteroscopic repair and mini-invasive transvaginal repair of niche (Abacjew-Chmylko et al., 2017).
AIM OF THE WORK
The aim of this study is to assess the prevalence of uterine niche with abnormal uterine bleeding in women after cesarean section.