ArticleHuman reproduction (Oxford, England)2015
Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development.
Article in Human reproduction (Oxford, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 90 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Does the Presence of Intracavitary Fluid During Hormonal Stimulation for IVF Depends on the Position of C-section-scar?
Factors Influencing the Development of Uterine Niche After Cesarean Delivery
The Influence of Endometrial Suturing During Cesarean Section on the Risk to Develop Uterine Scar Defect: A Randomized Control Study
A Prospective Controlled Ultrasound Based Study For Niche Development In The Uterine Cesarean Section Scar With Hysteroscopic Correlation In Symptomatizing Patients
Laparoscopic Versus Transvaginal Approaches in Repair of Uterine Niche: A Randomized Controlled Trial
Uterine Inflammatory Characteristics Following Cesarean Delivery
Incidence of Caesarean Scar Defect in Cases of Cesarean Section With and Without Bladder Flap Dissection
High Segmental Hysterotomy vs. Low Segmental Hysterotomy: Association With the Incidence of Uterine Wall Defects After Cesarean Section
Who cites it
90 citing papers in PubMed, 2 syntheses or guidelines pooled it, 238 citations in OpenAlex.
- Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials.Archives of gynecology and obstetrics · 2025Pooled it
- Pooled it
- Two-layer interrupted versus two-layer continuous sutures for preventing cesarean scar defect: a randomized controlled trial.BMC pregnancy and childbirth · 2025Trial
- The association of endometrial closure during cesarean section to the risk of developing uterine scar defect: a randomized control trial.Archives of gynecology and obstetrics · 2024Trial
- Cesarean scar dehiscence in early puerperium and influence of barbed suture: tridimensional ultrasound evaluation in a randomized clinical study.Acta cirurgica brasileira · 2024Trial
- Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial.Acta obstetricia et gynecologica Scandinavica · 2022Trial
- Effect of single- versus double-layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double-blind, randomised controlled superiority trial.BJOG : an international journal of obstetrics and gynaecology · 2021Trial
- Examining the relationship between cesarean section scar and endometrial cancer.Journal of gynecologic oncology · 2026Article
- Predicting bladder-to-uterine adhesions in patients undergoing hysterectomy using sliding-bladder sign technique with preoperative ultrasound: a diagnostic accuracy study.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026Article
- Determinants of First-Trimester Residual Myometrial Thickness After Previous Cesarean Delivery: A Retrospective Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- Uterine cystic adenomyoma arising from cesarean scar diverticulum: a case report and literature review.BMC pregnancy and childbirth · 2026Review
- Internal iliac artery balloon occlusion for placenta accreta spectrum disorder: outcomes and factors influencing efficacy.BMC pregnancy and childbirth · 2026Article
- The role of cesarean section surgical techniques in the prevention of isthmocele formation: retrospective cohort study.Archives of gynecology and obstetrics · 2026Article
- Role of CTGF-LRP1 in impaired healing of cesarean section incisions.Nature communications · 2026Article
- Isthmocele: from Detection to Treatment: A Narrative Review.Advances in therapy · 2026Review
- Impact of obstetric and surgical factors on isthmocele development: insights from a prospective cohort study.Archives of gynecology and obstetrics · 2026Article
- A Rare Case of Cesarean Scar Diverticulum Rupture Induced by Intrauterine Infection in a Non-Pregnant Woman.International medical case reports journal · 2026Article
- Clinical Outcomes of Laparoscopic Folding Suture for Cesarean Scar Defect and Its Impact on Pregnancy Outcomes: A Retrospective Study.International journal of women's health · 2026Article
- Uterine closure after cesarean delivery: surgical technique, biological rationale, and clinical implications.American journal of obstetrics and gynecology · 2026Review
- Isthmocele risk in repeated cesarean: the diagnostic and clinical role of morphometric parameters.Archives of gynecology and obstetrics · 2025Article
30 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.