{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:11:13Z","timestamp":1793394673795,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,12,26]],"date-time":"2013-12-26T00:00:00Z","timestamp":1388016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,1]]},"abstract":"Objective<\/jats:title>To study the prevalence of niches in the caesarean scar in a random population, and the relationship with postmenstrual spotting and urinary incontinence.<\/jats:p><\/jats:sec>Design<\/jats:title>A prospective cohort study.<\/jats:p><\/jats:sec>Setting<\/jats:title>A teaching hospital in the Netherlands.<\/jats:p><\/jats:sec>Population<\/jats:title>Non\u2010pregnant women delivered by caesarean section.<\/jats:p><\/jats:sec>Methods<\/jats:title>Transvaginal ultrasound (TVU<\/jats:styled-content>) and gel instillation sonohysterography (GIS<\/jats:styled-content>) were performed 6\u201312\u00a0weeks after caesarean section. Women were followed by questionnaire and menstruation score chart at 6\u201312\u00a0weeks, 6\u00a0months, and 12\u00a0months after caesarean section.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Prevalence of a niche 6\u201312\u00a0weeks after caesarean section, using TVU<\/jats:styled-content> and GIS<\/jats:styled-content>. Secondary outcomes: relation to postmenstrual spotting and urinary incontinence 6 and 12\u00a0months after caesarean section; and niche characteristics, evaluated by TVU<\/jats:styled-content> and GIS<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>Two hundred and sixty\u2010three women were included. Niche prevalence was 49.6% on evaluation with TVU<\/jats:styled-content> and 64.5% with GIS<\/jats:styled-content>. Women with a niche measured by GIS<\/jats:styled-content> reported more postmenstrual spotting than women without a niche (OR<\/jats:styled-content> 5.48, 95% CI<\/jats:styled-content> 1.14\u201326.48). Women with residual myometrium at the site of the uterine scar measuring <50% of the adjacent myometrial thickness had postmenstrual spotting more often than women with a residual myometrial thickness of >50% of the adjacent myometrial thickness (OR<\/jats:styled-content> 6.13, 95% CI<\/jats:styled-content> 1.74\u201321.63). Urinary incontinence was not related to the presence of a niche.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>A niche is present in 64.5% of women 6\u201312\u00a0weeks after caesarean section, when examined by GIS<\/jats:styled-content>. Postmenstrual spotting is more prevalent in women with a niche and in women with a residual myometrial thickness of <50% of the adjacent myometrium.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12542","type":"journal-article","created":{"date-parts":[[2013,12,26]],"date-time":"2013-12-26T10:28:29Z","timestamp":1388053709000},"page":"236-244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":246,"title":["Long\u2010term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding"],"prefix":"10.1111","volume":"121","author":[{"given":"LF","family":"van der Voet","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Deventer Hospital Deventer the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"Bij de Vaate","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Veersema","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology St Antonius Hospital Nieuwegein the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HAM","family":"Br\u00f6lmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAF","family":"Huirne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,26]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Stichting Perinatale Registratie Nederland.Perinatale zorg in Nederland 2008.Utrecht:Stichting Perinatale Registratie Nederland.2011[www.perinatreg.nl]. 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