Prevalence of Gynecologic Symptoms Associated with Cesarean Scar Disorder in Women with a Uterine Niche

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OBJECTIVES: To evaluate the prevalence of symptoms of consensus-defined cesarean scar disorder (CSDi) in nonpregnant women presenting with a history of cesarean delivery (CD) and a postpartum uterine niche. METHODS: We included women who underwent postpartum transvaginal ultrasound (TVS) evaluation of the CD scar between 2020 and 2022 at a specialized gynecological ultrasound clinic. Women diagnosed with a niche, using standardized ultrasound criteria, were invited to complete a structured telephone questionnaire assessing CSDi-related symptoms, based on international consensus criteria. A CSDi was diagnosed when at least 1 primary symptom or at least 2 secondary symptoms were present. RESULTS: Among 481 women evaluated, 72 (15.0%) were diagnosed with a uterine niche. Of these, 50 women (69.4%) completed the questionnaire and were included in the final analysis. The prevalence of post-cesarean scar disorder (PCSD) was 88.0% (44/50). Forty-one women (82.0%) met the diagnostic criteria based on at least 1 primary symptom. Pain during menstrual bleeding (42.0%) and secondary unexplained infertility combined with intrauterine fluid (22.0%) were the most frequent primary symptoms. Quality of life (QoL) scores ranged from 1 to 5, with a median score of 4 (mean ± SD, 3.96 ± 1.09). Most women (36/50, 72%) reported high QoL (score 4-5). CONCLUSIONS: We found an increase in the prevalence of self-reported CSDi-associated symptoms in nonpregnant women with a uterine niche after CD. Although their QoL was generally preserved, further evaluation is needed to determine the clinical relevance of CSDi, including its accurate prevalence and the distribution of symptoms by type and number of prior CDs.

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