A rising number of women are suffering from associated issues as the prevalence of cesarean deliveries (CD) increases globally. Some long-term maternal symptoms are considered to be related to the appearance of the uterine scar, and more specifically to a niche in the caesarean scar as a surrogate marker. We aimed to compare single layer and double-layer uterine closure as a risk factor for niche.

Methods: This prospective cohort study was carried out on 350 pregnant women between 18 to 45 years old and were admitted for CS either elective or selective, at the Department of Gynaecology and Obstetrics, Sohag University Hospital, Sohag, Egypt. All participating women were asked to answer a set of questions on symptoms and possible complaints, which had arisen since the CS. Participants were invited to a medical examination 6 months postoperatively, in which a 3D transvaginal ultrasonography (3D-TVUS) was performed to assess scar position and integrity after their CSs.

Results: There was a significant association between niche formation and uterine closure teqnique (P<0.001). The logistic regression analysis showed that uterine closure techniques were found to be significant predictors for niche presence among the studied participants. Women who had single uterine closure showed more than triple risk for developing niche compared to those with double layer non locked.

Conclusions: One of the most common long-term complications is the uterine niche, which had a prevalence of 67.4% in our study. Of the primary risk factors identified include is the use of single-layer closure during surgery