The association between uterine niche and secondary infertility by using different diagnostic tools: a prospective cohort study

Introduction: Uterine scarring develops because of every cesarean section. Some patients experience insufficient healing of the uterine scar following a cesarean section, which leads to the formation of the uterine niche. Magnetic resonance imaging, hysterosalpingography, hysteroscopy, two- or three-dimensional transvaginal ultrasound, and hysteroscopy can all be used to assess the uterine niche.Aim of the study: The purpose of this study was to compare the diagnostic performance of hydrosonography and hysterosalpingography in the evaluation of niche and subfertility.Subjects and Methods: 50 patients participated in this prospective cohort study, which was conducted in the outpatient obstetrics clinics at Fayoum University Hospital.Results: A statistically significant correlation was seen between the length of the uterus and the niche as determined by hydrosonography. After a cesarean section, hysterosalpingography detects a higher frequency of niches (56%). Hydrosonography detects a greater number of niches than hysterosalpingography, with larger observed niche sizes and uterine lengths; however, overall, there is strong, substantial agreement between the two methods regarding the niche.Conclusions: The myometrial defect known as the CS scar niche is unrelated to subfertility. In the diagnosis of niche, the study found a strong, significant concordance between the hysterosalpingography and the hydrosonography.