08/26/2026
This scar might be causing more than you think. New research from Dr. Camran Nezhat looks at cesarean scar defects — and what surgical repair can mean for symptoms and fertility.
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Forward we go! 🎗️
C-sections now account for roughly 30% of births — up sharply over the last decade. More C-sections means more attention needed on how the incision heals.
Also called a niche, isthmocele, or uterine diverticulum — this defect can form in 19–61% of patients after just one C-section, and can cause pain, irregular bleeding, and infertility.
Not closing the peritoneum, or using single-layer/locking sutures during closure, raises the risk. High BMI, gestational diabetes, and prior C-sections are risk factors too.
There are three ways to repair a cesarean scar defect: hysteroscopic, laparoscopic (with or without robotic assistance), or vaginal. The right one depends on the patient.
In Dr. Nezhat’s study of 27 patients, a two-layer, non-locked running suture was used — carefully avoiding the uterine cavity to reduce the risk of adhesions.
78% of patients saw significant improvement or resolution of symptoms. Of those hoping to conceive, 73% got pregnant, and 60% had a live birth.
Two key takeaways: the peritoneum should be closed during cesarean delivery, and a laparoscopic approach is recommended for those who want future fertility.
For those done having children: hysteroscopic repair if myometrial thickness is ≥3mm, laparoscopic repair if thinner, or hysterectomy as another option.
Full study linked in bio: Nezhat et al., “Outcomes of Laparoscopic Cesarean Scar Defect Repair,” Journal of Clinical Medicine, 2023.
Forward we go! 🎗️
