Uterine Niche: An Emerging Phenomenon

The rising caesarean section (CS) rate in many low-and middle-income countries is due to lack of access to epidural analgesia.Other reasons include increasing maternal requests for CSs, and earlier detection of maternal and foetal indications through improved monitoring modalities.This trend has led to complications such as morbid adherence of placenta, arteriovenous malformations (AV Malformations), and uterine niche formation.A uterine niche which is also called scar diverticulum, scar pouch, or isthmocele results from defective tissue healing.The authors report a case of a uterine niche in a 32-year lady with a history of two CSs and irregular heavy menstrual bleeding (HMB) for the past two years.Her ultrasound revealed a heterogeneous anterior myometrium with blood in the endometrial cavity.Contrast-enhanced magnetic resonance imaging (CE-MRI) revealed an outpocketing at the uterine scar site with blood flow from the uterine cavity into the structure identified as a CS niche.At laparotomy, a 55 cm niche was identified along the anterior uterine wall with a 33 cm fibroid attached to it.Excision of the uterine niche and scar repair was performed.The patient's recovery was uneventful.Histopathological examination revealed endocervical mucosa, endometrial mucosa, and fibroblastic stromal reaction, confirming the uterine niche.