3rd Annual Joint Meeting of the NEFS and Boston OB Society

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3rd Annual Joint Meeting of the NEFS and Boston OB Society

"Getting Into the Niche of It: When and How to Repair a Cesarean Scar Defect"

PRESENTED BY:

Caiyun Liao, MD MPH Assistant Professor, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UMASS Chan Medical School, Worcester, MA

Erica Robinson, MD FACS FACOG UMASS Chan Medical School, Worcester, MA

AGENDA

5:00-6:00 pm - Executive Committee Meeting (committee members only)

6:00 - Reception

6:30 - Buffet Dinner and Presentation

Session Summary:

Cesarean scar defect (CSD), also known as niche or isthmocele, is a byproduct of the rising prevalence of cesarean deliveries in recent years. CSDs can cause multiple gynecologic symptoms, such as chronic pain and abnormal uterine bleeding. It imposes risks of cesarean scar pregnancy, uterine rupture, placenta accreta spectrum in pregnancy. It can lower the probability of success in assisted reproductive technology (ART) cycles. Endometriosis often coexists with CSD, complicating management decisions. Evidence on prevention, diagnosis and surgical treatment strategies continues to evolve yet remains limited. In this session, an REI/ reproductive surgeon and a complex benign gynecologic surgeon with extensive experience in management of CSD will discuss up-to-date evidence on diagnosis of CSD, indications and techniques for surgical repair, and ways to minimize CSD formation at the time of cesarean deliveries.

Learning Objectives:

1. Identify cesarean scar defect, or uterine isthmocele, using standardized imaging criteria and key measurements, including depth of defect and residual myometrial thickness. Correlate these findings with symptoms, fertility status and goals, and counsel patients on reproductive risk.

2. Understand the effect of isthmocele on fertility, pregnancy outcomes, and assisted reproductive technology success, incorporating current evidence on pathophysiology and outcomes following surgical repair.

3. Select appropriate candidates and surgical approaches for isthmocele management based on symptoms, reproductive goals and preference, anatomic findings, and coexisting conditions such as endometriosis.