In the Netherlands, more than 30,000 women undergo a caesarean section every year. In nearly 18 thousand of them, a niche then forms, a bulging scar in the uterus. About 10,000 women continue to have complaints about this, such as abdominal pain, blood loss or fertility problems. Saskia Klein Meuleman cs (including Amsterdam UMC) have now given these complaints a name after consulting experts: Cesarean Scar Disorder (CSDi). In Jama Network Open they explain how they came to this.
A multitude of symptoms, conditions and therapies for niche patients have been reported in the literature so far. According to the authors, this lack of clarity makes it difficult to arrive at optimal treatments and advice. But through the well-known
Delphi method, Klein Meuleman et al. now reached consensus among 31 experts on the definition, symptoms, and diagnostic criteria of this disorder.
The main thing is that the niche must be confirmed by ultrasound. And that it concerns a range of complaints that affect premenopausal women and that persist for at least three months after the caesarean section. Furthermore, before a diagnosis of CSDi can be made, other diagnoses must be ruled out, such as cervical dysplasia, infection, pathology of the uterine cavity, or abnormal uterine bleeding due to ovulatory or other iatrogenic causes.
Klein Meuleman et al define CSDi as a uterine niche in combination with at least one primary or two secondary symptoms. Primary symptoms may include postmenstrual spotting, pain during uterine bleeding, technical difficulties with catheter insertion during embryo transfer, and secondary unexplained infertility. Secondary symptoms: dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoidance of sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-esteem, and discomfort while participating in leisure activities.
