Incidence of Cesarean Scar Niche After Primary Cesarean Section Repair by Three Different Techniques in Minia Maternity University Hospital – A Prospective Observational Study

Introduction: One common postoperative defect that can lead to, abnormal uterine bleeding, infertility,and pelvic pain is a cesarean scar niche. The process of uterine closure is crucial in the development of niches. Objective: evaluate and compare the occurrence and features of cesarean scar niches after a primary cesarean section using three different closure methods: single-layer, double layer non locking, and double layer with parallel closure. Methods: This randomized prospective observational study included 102 women undergoing elective primary cesarean section. Patients were randomized into three groups (n=34 each) based on uterine closure technique. Transvaginal sonography was performed at 3 and 6 months to assess niche presence, depth, residual myometrial thickness (RMT), and related symptoms. Results: Niche presence was highest in the single layer group (28.4% at 3 months; 41.5% at 6 months) and lowest in the parallel closure group (5.9% and 8.8%, respectively). Technique C (parallel closure) showed significantly less niche depth and higher RMT at both follow-ups. Symptomatic cases were also fewer within the parallel closure group. Conclusion: Parallel double-layer closure technique significantly reduces niche formation and improves uterine healing compared to other techniques. This technique may be preferable to minimize future gynecologic and obstetric complications.