(376) Absence of Post–Cesarean Delivery Niche in patients with endometrial-free hysterorrhaphy

Placenta accreta spectrum (PAS) is an entity associated with serious complications. The higher incidence of cesarean delivery is related to a higher incidence of PAS. Until now there is no valid strategy to prevent PAS; however, a relationship has been reported between the presence of extensive myometrial defects in the area where cesarean section was performed and an increased risk of developing PAS in a subsequent pregnancy. This observation gives relevance to strategies to reduce the postoperative niche after a first caesarean section.

Objective: We evaluated the presence of a niche in 12 patients undergoing their first c-section using an endometrial-free uterine closure technique (EFCT).

Study Design: Prospective observational study including patients undergoing their first cesarean section and in whom the myometrium was closed with a double layer of myometrial suture, free of endometrium. Six to twelve months after cesarean section, sonohysterography was performed to assess the presence of a niche. The hysterorrhaphy was videotaped and photographed to document the exclusion of the endometrium at the suture. 

Results:

Twelve women whose characteristics appear in Table 1 were included. In none of them was any myometrial defect observed in the area where the previous cesarean section was performed (Image 1).

Other authors have described a low frequency of PAS in patients whose first cesarean was sutured using EFCT. Similarly, the appearance of a postoperative niche has been described immediately after applying a single-locked, full-thickness uterine closure during a cesarean section.

Although our results are not conclusive and further research is required, the absence of a niche in 100% of patients treated with EFCT during their cesarean section supports the hypothesis that the hysterorrhaphy technique affects the appearance of the niche.


Conclusion: In a cohort of 12 patients undergoing cesarean section with EFCT, we did not observe postoperative niche. Additional studies are required to evaluate the relationship between the hysterorrhaphy technique and the appearance of the postoperative niche.