Cesarean scar niche

Last revised by Dr Mostafa El-Feky on 30 Sep 2021

The term Cesarean scar niche (defect) refers to the presence of a hypoechoic area within the myometrium in the isthmus (lower uterine segment) with discontinuation of myometrium at the site of previous Cesarean section scar. A niche has been described as the indentation of myometrium of around 1-2 mm 1,4 and due to tethering of the endometrium. 

They are encountered in various shapes such as:

  • semicircular: considered commonest 4
  • triangular: next commonest 4
  • droplet‐shaped
  • inclusion cysts

Due to tethering of the endometrium, blood accumulates in a niche and may serve as a source of dysfunctional uterine bleeding, accounting for spotting 2-12 days after the routine menstrual cycle 5.

See also

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Cases and figures

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