الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Caesarean delivery is one of the most common surgical procedures in women, with rates of 30% or more. The term CS niche (defect) describes the presence of a hypoechoic area within the myometrium in the isthmus (lower uterine segment) with discontinuation of myometrium at the site of previous CS. A niche has been described as the indentation of myometrium of at least 2 mm. Caesarean scar defect forms after Caesarean delivery, at the site of hysterotomy or Caesarean delivery, on the anterior wall of the uterine isthmus, While this is the typical location, the defect has also been found at the endocervical canal and mid-uterine body. Improper healing of the Caesarean incision leads to thinning of the anterior uterine wall, which creates an indentation and fluid-filled pouch at the Caesarean scar site. The exact reason why a niche develops has not yet been determined; however, there are several hypotheses, broken down by pregnancy-related and patient-related factors. Patients with Caesarean scar defect presented with some symptoms. These symptoms including delayed menstruation through the cervix, resulting in abnormal bleeding, pelvic pain, vaginal discharge, dysmenorrhea, dyspareunia, and infertility. The presence of a niche may be associated with obstetric complications in future pregnancies. Summary 88 Subfertility after Caesarean section may be related to the presence of a niche but can also be caused by other factors. It is important to realize that not all niches cause symptoms and that the relation between subfertility and a niche in the uterine scar still needs to be fully proved . The main aim of the study: The study was to assess the relationship between post Caesarean section niche and female subfertility. Methods: This study was an observational prospective cohort study. The study was carried out at the Department of Obstetrics and Gynecology. Tanta University Hospitals. All patients with secondary infertility for maximum 2 years who attended to our outpatient clinic underwent to the following: (Focused history taking, Examination, Investigational studies) The main results of the study showed that: Demographic data of the studied population showed non-significant difference between the studied 2 groups (CS with niche and without niche) as regard age, BMI, number of CS, time since last CS, time since stop of contraceptive method. As regard the clinical presentation of the studied 2 groups (CS with niche and without niche); intermenstrual bleeding, dysmenorrhea, dysparunea, pelvic pain were statistically significant higher in niche group than no niche group. As regard the obstetric outcome of the studied 2 groups (CS with niche and without niche) and the effect on fecundability; there is Summary 89 statistically significant lower pregnancy rate in CS with Niche group than CS without niche group. However there is no statistically significant difference between Niche group and no niche group as regard the abortion and CSP. As regard the ultrasonography data of CS with niche patients; 46.7% have IU fluid collection. 60% have AVF uterine position. The range and mean value of RMT was 3.526 ± 0.926, width was 10.9a82 ± 0.999 and depth was 3.541 ± 1.025 mm. As regard the endometrial thickness of the studied 2 groups (CS with niche and without niche); there is decrease in endometrial thickness in niche group but there is no statistically significant difference between Niche group and no niche group as regard the endometrial thickness. As regard the relation between intramenestrual spotting and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection, niche depth, endometrial thickness and lower RMT in patients with AUB. As regard the relation between dysmenorrhea and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection, endometrial thickness in patients with dysmenorrhea. As regard the relation between dyspareunia and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection, RVF uterine position, depth, endometrial thickness and lower RMT in patients with dyspareunia. As regard the relation between pregnancy and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection and RVF uterine position, depth and lower RMT and endometrial thickness in non-pregnant group.