Uterine niche is an iatrogenic pouch-like defect at the site of previous caesarean scar due to defective tissue healing. Uterine niche occurs in up to 70% women with previous cesarean of whom 30% are symptomatic. Reported prevalence varies: 24–70% with transvaginal sonography (TVS), Lower uterine incision towards the cervix, Cesarean section done in advanced labour after cervical effacement, Single-layer, decidua sparing closure technique predisposes to incomplete closure, Non- perpendicular sutures leading to an irregular myometrial closure, locking sutures or very tight second layer leading to is necrosis resulting poorly healed scar predisposing to niche formation. Thus, double-layer uterine closure using non-locking sutures is the optimal closure technique that results in thicker residual myometrium and hence potentially lower risk of niches.

Aim:
The aim of this study was to compare Incidence of cesarean scar defect in cases of cesarean section with and without bladder flap dissection

Patients and Methods:
268 women were randomly divided into two equal groups using double blind method with closed envelopes
• Group (A) 134 were subjected to traditional cesarean section with bladderflap dissection after blunt entry into peritoneum and before entry to uterus.
• Group (B) 134 were subjected to traditional cesarean section with entry into uterus directly after blunt entry into peritoneum without bladder flap dissection.