Aetiology, risk factors and preventive strategies for niche development: A review.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101121582 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-1932 (Electronic) Linking ISSN: 15216934 NLM ISO Abbreviation: Best Pract Res Clin Obstet Gynaecol Subsets: MEDLINE
    • Publication Information:
      Publication: 2002- : Amsterdam : Elsevier
      Original Publication: Amsterdam : Harcourt Publishers, c2001-
    • Subject Terms:
    • Abstract:
      The increase in caesarean sections (CS) has resulted in an increase in women with a uterine niche. The exact aetiology of niche development has yet to be elucidated but is likely multifactorial. This study aimed to give a systematic overview of the available literature on histopathological features, risk factors and results of preventive strategies on niche development to gain more insight into the underlying mechanisms. Based on current published data histopathological findings associated with niche development were necrosis, fibrosis, inflammation, adenomyosis and insufficient approximation. Patient-related risk factors included multiple CS, BMI and smoking. Labour-related factors were CS before onset of labour, extended cervical dilatation, premature rupture of membranes and presenting part of the fetus at CS below the pelvic inlet. Preventive strategies should focus on the optimal level of incision, training of surgeons and full-thickness closure of the myometrium (single or double-layer) using non-locking sutures. Conflicting data exist concerning the effect of endometrial inclusion. Future studies without heterogeneity in population, using standardized performance of the CS after proper training and using standardized niche evaluation with a relevant core outcome set are required to allow meta-analyses and to develop evidence-based preventive strategies. These studies are needed to reduce the prevalence of niches and prevent complications in subsequent pregnancies such as caesarean scar pregnancies.
      Competing Interests: Declaration of competing interest The authors have no conflict of interest.
      (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
    • Contributed Indexing:
      Keywords: Aetiology; Caesarean section; Niche; Niche development; Prevention; Risk factors
    • Publication Date:
      Date Created: 20230629 Date Completed: 20230911 Latest Revision: 20230911
    • Publication Date:
      20240829
    • Accession Number:
      10.1016/j.bpobgyn.2023.102363
    • Accession Number:
      37385157