Comparison between Intraoperative Surgical Techniques for Prevention of Uterine Niche Formation after Cesarean Section

Background: Isthmocele, also known as cesarean scar defect (CSD), is a condition associated with obstetric and gynecological problems such infertility, pelvic pain, placenta accreta, and cesarean scar pregnancy. As the number of cesarean deliveries has climbed, so has its incidence. In addition to the incision location, adhesions, ischemia, and poor healing, uterine closure method is a crucial component. Objective: To evaluate how well various intraoperative surgical methods, particularly the uterine incision site and closure technique, prevent the formation of uterine niches following cesarean sections (CS). Patients and Methods: Thirty women receiving CS at Al-Rahmaniya Central Hospital and Dar Al-Umouma and Al-Shorouk Private Hospitals (Elbehira, September 2024 and September 2025) were split into two groups at random for this prospective interventional trial. Group B (n = 15) had low transverse incisions with continuous interlocking single-layer closure, whereas Group A (n = 15) had high transverse incisions with double-layer closure. Time to niche development was evaluated using Kaplan-Meier analysis. Results: The median survival period for both groups was five months, and the mean time to niche formation was 5.333 months (95% CI: 4.878–5.789) for Group A and 5.467 months (95% CI: 5.003–5.930) for Group B. The Kaplan-Meier curves almost overlapped, suggesting that there was no discernible difference between the methods. Conclusion: Although there were no statistically significant differences, double-layer closure somewhat increased myometrial thickness and decreased niches. Niche creation seems to be multifaceted, impacted by morphological, surgical, and patient factors. To maximize scar healing, standardized incision and closure procedures are advised.