Assessment of Cesarean Niche by Transvaginal Ultrasonography and Pelvic Magnetic Resonance Imaging

Abstract

Background: Transvaginal ultrasonography (TVUS) is the predominant technique used to assess the uterine wall. Objectives: of this study was to compare TVUS with pelvic MRI in identifying the cesarean niche. Patients and Methods: This prospective cohort study was carried out on 30 non-pregnant women aged from 20 to 40 years old, who complaining from postmenstrual spotting, dysmenorrhea, chronic pelvic pain and dyspareunia undergoing at least one cesarean section (CS). All patients were categorized into two equal groups: Group A: (Detected CS Niche) and Group B: (No Detected CS Niche). Results: The cutoff value of 3.9 mm, the residual myometrial thickness (RMT) by anteverted uterus (TVS) variable had a sensitivity of 87.8%, a specificity of 71.3% and AUC 0.771 for predicting niche and indicated that at the cutoff value of 4.15 mm, the RMT by MRI variable had a sensitivity of 88.3%, a specificity of 70.6% and AUC 0.781 for predicting niche. Cesarean niche detected measurement were significantly increase with MRI when compared with TVS (P<0.05). AVF was significantly reported in cases with no detected CS Niche. Regarding age, number of previous CS, parity, breech, transverse presentation, single layer, use of locking sutures, chronic use of steroids during pregnancy, pre-eclampsia, and peri- or postpartum fever or infection, there was significantly increased in both groups (P<0.0001). Conclusion: MRI shows promise in evaluating the thickness of uterine scars by reducing the reliance on the operator, which is a limitation of TVUS, and providing more precise measurements compared to TVUS.

Keywords

• cesarean niche transvaginal ultrasonography
• pelvic magnetic resonance imaging cesarean section