Clinical Consensus No. 463: Diagnosis and Management of Cesarean Scar Niche.

OBJECTIVE

This consensus statement aims to guide clinicians in the diagnosis, management and prevention of cesarean scar niche.

TARGET POPULATION: Patients undergoing cesarean delivery or patients with cesarean scar disorder.

OPTIONS: Options for management include expectant, medical and surgical management. These will depend on symptoms, residual myometrial thickness, and future fertility plans.

OUTCOMES: Outcomes include resolution of symptoms, repair of defect and subsequent successful pregnancy.

BENEFITS, HARMS, AND COSTS: This guideline aims to benefit patients undergoing cesarean delivery or those suffering from cesarean scar disorder and to offer healthcare providers an evidence-based approach to the prevention, diagnosis and management of cesarean scar defects.

EVIDENCE: Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified between January 1st, 2005 and April 30th, 2025 using the search terms "cesarean scar niche", "cesarean scar defect", and "isthmocele". Results were restricted to studies written in English.

VALIDATION

METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A.

INTENDED AUDIENCE: All health care providers who perform cesarean delivery or who care for patients who have previously undergone a cesarean delivery and may be experiencing symptoms of cesarean scar disorder, including obstetrician gynaecologists, family physicians, registered nurses, nurse practitioners and radiologists.

TWEETABLE ABSTRACT: Cesarean scar niche is a common consequence of cesarean delivery. Symptomatic patients suffering from cesarean scar disorder can be treated expectantly or with medical or surgical options. Asymptomatic patients do not require treatment.

SUMMARY STATEMENTS: RECOMMENDATIONS.