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Journal of Ultrasound in Medicine, Vol 20, Issue 10 1105-1115, Copyright © 2001 by American Institute of Ultrasound in Medicine
Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar
A. Monteagudo, C. Carreno and I. E. Timor-Tritsch
Department of Obstetrics and Gynecology, New York University School of Medicine, New York, 10016, USA.
OBJECTIVE: To apply an existing diagnostic imaging test (saline infusion
sonohysterography) to characterize the "filling defect" of a previous
cervical cesarean delivery scar in the nonpregnant uterus. METHODS:
Forty-four patients with histories of cesarean delivery who underwent
saline infusion sonohysterography for a variety of gynecologic indications
were included. During the procedure, the area below the bladder recess was
examined using transvaginal sonography. A filling defect or "niche" was
defined as a triangular anechoic structure at the presumed site of a
previous cesarean delivery scar. The depth of the niche was measured.
Uterine size, the presence of fibroids and polyps, and the number of
previous cesarean deliveries were noted. RESULTS: All patients had a niche
indenting the anterior uterine-cervical wall. The mean +/- SD depth of the
niche was 6.17 +/- 3.6 mm. There was no correlation between the number of
cesarean deliveries and the depth of the niche. Thirty-six percent of our
patients had fibroids, and 18% had endometrial polyps. CONCLUSION: Saline
infusion sonohysterography was able to detect filling defects in women who
previously had cesarean deliveries. We hope that by focusing our attention
on the transvaginal sonographic appearance of the detectable uterine scar
(niche) with or without the use of saline infusion sonohysterography in the
nonpregnant uterus, it will train our eyes to look for the scar in the
pregnant uterus. In addition, our study patients had a high prevalence of
abnormal uterine bleeding. The role of the cesarean delivery scar in women
with unscheduled bleeding needs to be further evaluated.
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