الفهرس 
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Abstract
The prevalence of CS scar morphological ‘abnormalities’ has been studied in non‐pregnant women using TVUS in seven publications over the last 10 years. The incidence of CS scars with an apparent ‘defect’ ranged from 6.9% to 69%. Different methods of classifying CS scars have been applied, based on the dimensions of the scar and its relation to the internal cervical os and the uterine fundus. In all the studies cited, a scar ‘defect’ or ‘niche’ was defined by the presence of a hypoechogenic area within the myometrium of the LUS, at the site of a previous CS. Despite similar imaging protocols, there was no agreement between the seven studies regarding the definition of scar‐apparent ‘defects’, and so the real prevalence of the different morphological subgroups of CS scars is unknown (Naji et al., 2011). GIS (Gel instillation sonohystrography) is an easy diagnostic method to perform and the higher viscosity of the gel causes less fluid leakage. Although backflow could not be prevented completely, GIS gives stable distension during at least 4–5 min, which is sufficient to complete the ultrasound evaluation. Small fluctuations of the distension in time may be caused by contractions of the uterine muscle. For better performance of GIS, commercial products are available containing gel with a smaller amount of dissolved molecules, no need to transfer the gel manually from one syringe to another and with a special cervical applicator preventing cervical backflow or leakage (Bij De Vaate et al., 2010). We aimed in this study to compare gel Instillation sonohysterography with TV ultrasound alone in assessment of caesarean section scar in non-pregnant women. Also, to determine the prevalence of ceaserian scar defect (niche or isthmocele). Patients and methods This prospective observational study conducted on 100 subjects attending Department of Obstetrics and Gynecology in Benha University Hospitals between June, 2019 and October, 2020. This study reported the results of comparison of TVUS and GIS in evaluation of CS scar in non pregnant women . Inclusion criteria: Women with previous one caesarean section since at least six months: this time point was chosen based on a previously reported healing time of six months of caesarean scar (Dicle et al., 1997). Results Regarding Sonographic characteristics evaluation of C.S niche by TVS and GIS, there was a statistically significant difference regarding Length of defect (P= 0.017), Height of defect (P= 0.035), Myometrial thickness adjacent to the defect (P= 0.013). Triangle parameter was the most observed Niche classification (48%) by gel instillation sonohysterography. Also, semicircle, droplet and inclusion cyst, and rectangle are 24%, 16%, 8% and 4% respectively.