{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:23:21Z","timestamp":1792113801928,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["843002605"],"award-info":[{"award-number":["843002605"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>A symptomatic uterine niche is a long\u2010term complication after a cesarean section (CS). A group of international niche experts reached consensus on a standardized definition of a disorder caused by a symptomatic niche, named cesarean scar disorder (CSDi). However, the prevalence of this disorder is unclear. The aim of this study was to assess the prevalence of CSDi in patients 3\u2009years after a first CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>A secondary analysis was performed on the 3\u2010year follow\u2010up results of the 2Close study. The 2Close study was a multicenter randomized controlled trial that evaluated single\u2010 versus double\u2010layer uterine closure at CS in 32 hospitals in the Netherlands and included 2292 patients (registered in Dutch trial register: [NTR5480]). Patients, aged \u226518\u2009years, undergoing a first CS were included. Three months after their CS, transvaginal ultrasonography was performed to evaluate the uterine scar for the presence of a niche. Three years after their CS, a digital questionnaire was sent to evaluate the primary and secondary symptoms of CSDi. For this secondary analysis, patients were excluded if they were pregnant, breastfeeding, or using hormonal contraception. The primary outcome of the study was the prevalence of CSDi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1648 participants who completed the 3\u2010year questionnaire, patients were excluded due to pregnancy or breastfeeding (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009305), use of hormonal contraception (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009509), missing ultrasound evaluations (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200976), and incomplete responses (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200988). Of the 670 patients included in this analysis, 543 (81.0%) had a uterine niche visible on ultrasound and 127 (19.0%) were without a niche. The prevalence of CSDi at 3\u2009years following a first CS was 42.5% (285\/670). Most reported symptoms were chronic pelvic pain (35.0%), postmenstrual spotting (32.8%), and abnormal vaginal discharge (23.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study found a high prevalence of CSDi 3\u2009years following their first CS. Symptoms were self\u2010reported and the exclusion criteria of pregnancy, breastfeeding, or hormonal contraception use could have introduced selection bias. Therefore, this percentage could be an overestimation of the actual prevalence. However, this high prevalence should be included in counseling patients with a scheduled CS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70005","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T07:41:46Z","timestamp":1755762106000},"page":"1972-1979","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Prevalence of cesarean scar disorder in patients 3\u2009years after a first cesarean section"],"prefix":"10.1111","volume":"104","author":[{"given":"Saskia J. M.","family":"Klein Meuleman","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carry","family":"Verberkt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere N.","family":"Barri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Medicine Hospital Universitario Dexeus  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ally","family":"Murji","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Toronto, Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Donnez","sequence":"additional","affiliation":[{"name":"Complex Endometriosis Center, Polyclinique Urbain V, (Elsan Group)  Avignon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigoris","family":"Grimbizis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology Medical School, Aristotle University of Thessaloniki  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ertan","family":"Saridogan","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Unit Elizabeth Garrett Anderson Wing Institute for Women's Health, University College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Bourne","sequence":"additional","affiliation":[{"name":"Institute for Reproductive and Developmental Biology, Imperial College London  London UK"},{"name":"Department of Development and Regeneration Katholieke Universiteit Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Pomorski","sequence":"additional","affiliation":[{"name":"2nd Department of Gynaecology and Obstetrics Wroclaw Medical University  Wroclaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichiro","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Shiga University of Medical Science  Otsu Shiga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"van den Bosch","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration Katholieke Universiteit Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynecology University Hospital KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne I.","family":"Stegwee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-2677","authenticated-orcid":false,"given":"Judith A. 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