Case challenge · Imaging / Gynecology / Ultrasound · teaching

Cesarean Scar Niche (Isthmocele) Imaging · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on TVUS / SIS

Case #1Imaging / Gynecology / Ultrasound

📋 Case data

Niche assessment (RMT and symptoms)Symptomatic (abnormal bleeding/secondary infertility) and thin RMT

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Niche assessment (RMT and symptoms)

Scar niche — residual myometrial thickness (RMT) and symptoms?

💡 A niche (isthmocele) = poorly healed cesarean scar causing an indentation + thinned myometrium; postmenstrual spotting/dysmenorrhea/chronic pelvic pain/secondary infertility (retained blood, affecting cervical mucus and sperm). TVUS (examine when the endometrium is thinnest postmenstrually) + SIS show it better; measure niche depth, RMT, adjacent myometrium; risk factors multiple cesareans/smoking/diabetes/retroverted uterus. It is the CSP implantation site.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.