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Post Cesarean Section Appearance
Maryam Rezvani, MD; Jeffrey Dee Olpin, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • C-section scar, niche, pouch, diverticulum, isthmocele
          • Definitions

            • Acute post cesarean section
              • Changes normally seen in puerperium or postpartum period (delivery to 6-8 weeks)
            • Chronic post cesarean section
              • Changes normally seen after remote hysterotomy for cesarean section

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Hysterosalpingography

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Gonzalo-Carballes M et al: A pictorial review of postpartum complications. Radiographics. 40(7):2117-41, 2020
                                      2. Wang SS et al: Imaging of postpartum/peripartum complications. Radiol Clin North Am. 58(2):431-43, 2020
                                      3. Tulandi T et al: Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 23(6):893-902, 2016
                                      4. Rezvani M et al: The role of multimodality imaging after cesarean delivery. Ultrasound Q. 31(1):5-18, 2015
                                      5. Laifer-Narin SL et al: Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging. Curr Probl Diagn Radiol. 43(6):374-85, 2014
                                      6. Hiller N et al: CT appearance of the pelvis after Cesarean delivery--what is considered normal? Clin Imaging. 37(3):514-9, 2013
                                      7. Plunk M et al: Imaging of postpartum complications: a multimodality review. AJR Am J Roentgenol. 200(2):W143-54, 2013
                                      8. Naji O et al: Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 39(3):252-9, 2012
                                      9. Rodgers SK et al: Imaging after cesarean delivery: acute and chronic complications. Radiographics. 32(6):1693-712, 2012
                                      10. Wang CB et al: Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 34(1):85-9, 2009
                                      11. Koskas M et al: Abdominal and pelvic ultrasound findings within 24 hours following uneventful cesarean section. Ultrasound Obstet Gynecol. 32(4):520-6, 2008
                                      12. Surapaneni K et al: Cesarean section scar diverticulum: appearance on hysterosalpingography. AJR Am J Roentgenol. 190(4):870-4, 2008
                                      13. Fabres C et al: Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect. J Minim Invasive Gynecol. 12(1):25-8, 2005
                                      14. Cheung VY et al: Sonographic evaluation of the lower uterine segment in patients with previous cesarean delivery. J Ultrasound Med. 23(11):1441-7, 2004
                                      15. Fabres C et al: The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 22(7):695-700; quiz 701-2, 2003
                                      16. Lydon-Rochelle M et al: Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 345(1):3-8, 2001
                                      17. Monteagudo A et al: Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar. J Ultrasound Med. 20(10):1105-15, 2001
                                      18. Suzuki S et al: Preoperative diagnosis of dehiscence of the lower uterine segment in patients with a single previous caesarean section. Aust N Z J Obstet Gynaecol. 40(4):402-4, 2000
                                      19. Erickson SS et al: Intermenstrual bleeding secondary to cesarean scar diverticuli: report of three cases. Obstet Gynecol. 93(5 Pt 2):802-5, 1999
                                      20. Thurmond AS et al: Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 18(1):13-6; quiz 17-8, 1999
                                      21. Fernandez E et al: Hysteroscopic correction of cesarean section scars in women with abnormal uterine bleeding. J Am Assoc Gynecol Laparosc. 3(4, Supplement):S13, 1996
                                      22. Woo GM et al: The pelvis after cesarean section and vaginal delivery: normal MR findings. AJR Am J Roentgenol. 161(6):1249-52, 1993
                                      23. Twickler DM et al: CT appearance of the pelvis after cesarean section. AJR Am J Roentgenol. 156(3):523-6, 1991
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • C-section scar, niche, pouch, diverticulum, isthmocele
                                              • Definitions

                                                • Acute post cesarean section
                                                  • Changes normally seen in puerperium or postpartum period (delivery to 6-8 weeks)
                                                • Chronic post cesarean section
                                                  • Changes normally seen after remote hysterotomy for cesarean section

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Hysterosalpingography

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Gonzalo-Carballes M et al: A pictorial review of postpartum complications. Radiographics. 40(7):2117-41, 2020
                                                                          2. Wang SS et al: Imaging of postpartum/peripartum complications. Radiol Clin North Am. 58(2):431-43, 2020
                                                                          3. Tulandi T et al: Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 23(6):893-902, 2016
                                                                          4. Rezvani M et al: The role of multimodality imaging after cesarean delivery. Ultrasound Q. 31(1):5-18, 2015
                                                                          5. Laifer-Narin SL et al: Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging. Curr Probl Diagn Radiol. 43(6):374-85, 2014
                                                                          6. Hiller N et al: CT appearance of the pelvis after Cesarean delivery--what is considered normal? Clin Imaging. 37(3):514-9, 2013
                                                                          7. Plunk M et al: Imaging of postpartum complications: a multimodality review. AJR Am J Roentgenol. 200(2):W143-54, 2013
                                                                          8. Naji O et al: Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 39(3):252-9, 2012
                                                                          9. Rodgers SK et al: Imaging after cesarean delivery: acute and chronic complications. Radiographics. 32(6):1693-712, 2012
                                                                          10. Wang CB et al: Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 34(1):85-9, 2009
                                                                          11. Koskas M et al: Abdominal and pelvic ultrasound findings within 24 hours following uneventful cesarean section. Ultrasound Obstet Gynecol. 32(4):520-6, 2008
                                                                          12. Surapaneni K et al: Cesarean section scar diverticulum: appearance on hysterosalpingography. AJR Am J Roentgenol. 190(4):870-4, 2008
                                                                          13. Fabres C et al: Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect. J Minim Invasive Gynecol. 12(1):25-8, 2005
                                                                          14. Cheung VY et al: Sonographic evaluation of the lower uterine segment in patients with previous cesarean delivery. J Ultrasound Med. 23(11):1441-7, 2004
                                                                          15. Fabres C et al: The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 22(7):695-700; quiz 701-2, 2003
                                                                          16. Lydon-Rochelle M et al: Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 345(1):3-8, 2001
                                                                          17. Monteagudo A et al: Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar. J Ultrasound Med. 20(10):1105-15, 2001
                                                                          18. Suzuki S et al: Preoperative diagnosis of dehiscence of the lower uterine segment in patients with a single previous caesarean section. Aust N Z J Obstet Gynaecol. 40(4):402-4, 2000
                                                                          19. Erickson SS et al: Intermenstrual bleeding secondary to cesarean scar diverticuli: report of three cases. Obstet Gynecol. 93(5 Pt 2):802-5, 1999
                                                                          20. Thurmond AS et al: Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 18(1):13-6; quiz 17-8, 1999
                                                                          21. Fernandez E et al: Hysteroscopic correction of cesarean section scars in women with abnormal uterine bleeding. J Am Assoc Gynecol Laparosc. 3(4, Supplement):S13, 1996
                                                                          22. Woo GM et al: The pelvis after cesarean section and vaginal delivery: normal MR findings. AJR Am J Roentgenol. 161(6):1249-52, 1993
                                                                          23. Twickler DM et al: CT appearance of the pelvis after cesarean section. AJR Am J Roentgenol. 156(3):523-6, 1991