Cesarean Section; Dehiscence Clinical Trial
Official title:
Role of Magnetic Resonance Imaging in Evaluation of Uterine Cesarean Section Scar Niche
To evaluate cesarean section scar and the lower uterine segment in non pregnant woman by MRI
to :
1. Assess the clinical symptoms like postmenstrual spotting or prolonged menstrual
bleeding, dysmenorrhea, chronic pelvic pain and dyspareunia and its relation to the
presence of cesarean scar defects and its characteristics .
2. development of scoring system and correlating it with the symptoms .
With increasing cesarean section rate nowadays, the risks of cesarean scar defect (CSD)
should increase. CSD is defined by ultrasound imaging as a triangular hypoechoic defect in
the myometrium at the site of the previous cesarean section scar. However, patients with CSD
are sometimes asymptomatic. Yet, some patients with CSD can have symptoms of abnormal uterine
bleeding, pelvic pain, infertility, uterine rupture, and potential risks of adverse pregnancy
outcome .There is an association between the size of a niche and postmenstrual spotting.
women with a history of CS, the depth and shape of the niche were not significant factors,
while a larger niche volume was described in women with postmenstrual spotting. in women with
gynecological symptoms, the niches were significantly wider in women with postmenstrual
spotting, dysmenorrhea or chronic pelvic pain, and the prevalence of postmenstrual spotting
or prolonged menstrual bleeding was higher with a larger diameter of the niche .Magnetic
resonance imaging (MRI) has recently shown a promise tool for evaluation of uterine scar
thickness. As opposed to ultrasonography (USG), which is the current gold standard for this
purpose, MRI reduces observer dependence and has a superior multiplanar capability.
MRI can be used for assessment of lower uterine segment. It provides accurate tissue
characterization, independent of patient body mass index .
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