RISK FACTORS CAUSING CAESARIAN SECTION SCAR NICHE

Abstract

Objective: This study aimed to identify and evaluate the potential risk factors associated with the formation of a cesarean section (CS) scar niche.

Methods: An observational case-control study was conducted over six months, involving 150 women with a previous lower segment CS. Participants were divided into a case group (n=75) with a sonographically confirmed niche and a control group (n=75) without a niche. Data on demographic, obstetric, and surgical factors were collected via interviews and medical records. Transvaginal ultrasonography (TVS) was used to diagnose and measure the niche. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

Results: Univariate analysis revealed significant associations between niche formation and multiple (≥2) CS, the indication for the last CS, and single-layer uterine closure. In the multivariate model, three factors emerged as independent predictors: multiple cesarean sections (adjusted Odds Ratio [aOR] 4.85, 95% CI 2.30-10.22), single-layer uterine closure (aOR 3.62, 95% CI 1.72-7.62), and an interval of more than two years since the last CS (aOR 2.91, 95% CI 1.38-6.15).

Conclusion: The most significant independent risk factors for CS scar niche formation are a history of multiple cesarean sections, the use of a single-layer uterine closure technique, and a longer postoperative interval. These findings underscore the importance of adopting double-layer uterine closure and providing cautious counseling on the risks of repeat cesarean deliveries to mitigate this long-term complication.