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A systematic review synthesized evidence linking caesarean scar defects, also called isthmocele or niche, to postmenstrual spotting and other morbidity, including abnormal uterine bleeding, pelvic pain and infertility. Diagnostic criteria and management approaches remain heterogeneous and poorly standardized. Findings were narratively synthesized from comprehensive searches across major medical databases managed in EndNote X9. Across studies, postmenstrual spotting predominated with dysmenorrhoea and pelvic pain, and intervention choices varied by residual myometrium and fertility concerns. Evidence quality was moderate, limited by small samples and heterogeneity, supporting the need for standardized diagnostic definitions and well-designed prospective research.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-systematic-review-on-caesarean-niche-and-postmenstrual-spotting-syndrome-the-scar-that-speaks/437360/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-systematic-review-on-caesarean-niche-and-postmenstrual-spotting-syndrome-the-scar-that-speaks/437360.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the caesarean scar defect (isthmocele/niche) described in this review?","Question",{"text":112,"@type":113},"It is a defect in the anterior lower uterine wall at the site of a previous caesarean section, typically visualized on transvaginal ultrasound as an indentation. It is thought to result from incomplete myometrial healing after hysterotomy closure.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why is postmenstrual spotting considered a key symptom in caesarean scar defects?",{"text":117,"@type":113},"Postmenstrual spotting is the symptom most consistently associated with these defects. Women often report a persistent brownish discharge for several days after menstruation ends, which can be distressing and may be dismissed as minor.",{"name":119,"@type":110,"acceptedAnswer":120},"What interventions are commonly reported, and what outcomes were described?",{"text":121,"@type":113},"Hysteroscopic resection was the most widely reported intervention, usually associated with improved bleeding patterns and related symptoms. Laparoscopic and vaginal repairs were more often used when residual myometrium was thin or fertility was a concern, with many reports describing favorable reproductive outcomes.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},437360,1790795568,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 10/27/2025  \nReview ended 11/21/2025  \nPublished 12/05/2025  \n© Copyright 2025  \nSaifaldeen Abdalrahman Damra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98509  \nOpen Access Review Article  \nA Systematic Review on Caesarean Niche and Postmenstrual Spotting Syndrome: The Scar That Speaks  \nSaja Saifaldeen Abdalrahman Damra 1, 2 , Athkar Yasir Hussien Abdalla 3 , Sara Awad Fageer Farah 4, 5 , Salma Awadelkarim Elshikh Ahmed 6, Abdelrahman Edris Osman Ali 7, Roua Ahmed Abbas 8, Asim Ahmed 9  \n1. Department of Obstetrics and Gynecology, Faculty of Medicine, Gadarif University, Gadarif, SDN 2. Department of Obstetrics and Gynecology, Faculty of Medicine, Baghdad University, Baghdad, IRQ 3 . Department of Obstetrics and Gynecology, Faculty of Medicine, University of Gezira, Wad Madani, SDN 4. Faculty of Medicine, Red Sea University, Port Sudan, SDN 5. Department of Obstetrics and Gynecology, Tabargal General Hospital, Tabargal, SAU 6. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bahri, Khartoum, SDN 7. Department of Obstetrics and Gynecology, Faculty of Medicine, Omdurman Islamic University, Khartoum, SDN 8. Department of Obstetrics and Gynecology, Faculty of Medicine, Sudan International University, Khartoum, SDN 9. Department of Research and Studies, 10 Scholars Academy, Riyadh, SAU  \nCorresponding author: Athkar Yasir Hussien Abdalla, [athkaryasir@gmail.com](athkaryasir@gmail.com)  \nAbstract  \nThe global increase in caesarean section rates has intensified concern about long-term gynaecological outcomes. Among these, the caesarean scar defect, also known as isthmocele or niche, has emerged as a notable cause of postmenstrual spotting, abnormal uterine bleeding, and infertility. Despite its clinical relevance, diagnostic criteria and management strategies remain heterogeneous and poorly standardised. This systematic review synthesised existing evidence on the association between caesarean scar defects and postmenstrual spotting, while also describing commonly used diagnostic approaches, symptom profiles, and reported management outcomes. Comprehensive searches of major medical databases were undertaken, with records managed in EndNote X9 and findings synthesised narratively. Across the literature, postmenstrual spotting was the predominant manifestation, frequently accompanied by pelvic pain, dysmenorrhoea, and infertility. Hysteroscopic resection was the most widely reported intervention, with most reports describing improvement in bleeding patterns and related symptoms, whereas laparoscopic and vaginal repairs were more often used in women with thin residual myometrium or fertility concerns and were associated with favourable reproductive outcomes. Overall, the evidence base was moderate in quality, limited by small sample sizes and clinical heterogeneity. Caesarean scar defects show a strong association with postmenstrual spotting and related morbidity, underscoring the need for standardised diagnostic definitions and well-designed prospective studies to guide clinical practice.  \nCategories: Obstetrics/Gynecology, General Surgery  \nKeywords: abnormal uterine bleeding, caesarean scar defect, hysteroscopy, infertility, isthmocoele, laparoscopy, postmenstrual spotting  \nIntroduction And Background  \nIntervention to one of the most frequently performed surgical procedures worldwide, as highlighted by global estimates of rising caesarean section rates [1] . In many regions, caesarean section rates now exceed 30%, and in some countries, they approach or surpass 50% of all births. While this surgical option remains indispensable for maternal and neonatal safety in specific obstetric contexts, its dramatic rise has inevitably drawn attention to long-term conseq","cbCaidvPXg4n140n","https://ap.wps.com/l/cbCaidvPXg4n140n","pdf",1002742,13,"English","# Introduction And Background\n## Caesarean section rates and long-term sequelae\n## Caesarean scar defect (isthmocele/niche): definition and visualization\n## Postmenstrual spotting as the main clinical manifestation\n## Impact on quality of life and diagnostic delays\n# Abstract\n## Evidence synthesis and methods\n## Symptom patterns across the literature\n## Reported interventions and outcomes\n## Evidence quality and research needs","[{\"question\":\"What is the caesarean scar defect (isthmocele/niche) described in this review?\",\"answer\":\"It is a defect in the anterior lower uterine wall at the site of a previous caesarean section, typically visualized on transvaginal ultrasound as an indentation. It is thought to result from incomplete myometrial healing after hysterotomy closure.\"},{\"question\":\"Why is postmenstrual spotting considered a key symptom in caesarean scar defects?\",\"answer\":\"Postmenstrual spotting is the symptom most consistently associated with these defects. Women often report a persistent brownish discharge for several days after menstruation ends, which can be distressing and may be dismissed as minor.\"},{\"question\":\"What interventions are commonly reported, and what outcomes were described?\",\"answer\":\"Hysteroscopic resection was the most widely reported intervention, usually associated with improved bleeding patterns and related symptoms. Laparoscopic and vaginal repairs were more often used when residual myometrium was thin or fertility was a concern, with many reports describing favorable reproductive outcomes.\"}]","A Systematic Review on Caesarean Niche and Postmenstrual Spotting Syndrome - The Scar That Speaks | PDF",1790681273,33]