General information

This study was set up by the VU University Medical Center and will be performed by gynaecologists in various hospitals. 

The Medical Ethical Committee has approved this study. General information about assessing research can be found in the leaflet ‘Medical scientific research’.

Background to the study

Research shows that women who underwent a Caesarean section may have a defect in the uterus at the location of the scar of the former Caesarean section. The defect is called a niche. This defect can be revealed the use of a water or gel contrast ultrasound scan.

You have such a niche. Currently, a laparoscopic niche resection has performed as a standard treatment to women with a large niche and who have gynaecological complaints, because this surgery has been shown to reduce the symptoms of haemorrhaging and pain.

During a laparoscopic niche resection the recess is removed and the uterus is repaired by a laparoscopic surgery. This has proven to be a safe method.

There are also indications that a niche hampers the realization of a subsequent pregnancy, e.g., if fluid collects in the niche or the uterus, which might make it difficult for an embryo to lodge itself properly, thus preventing a pregnancy.

Whether a niche really does have a negative effect has been insufficiently researched to date, which is why no standard treatment is offered to women with a large niche who have not yet managed to get pregnant. We have noticed that more than half of the women who have undergone a laparoscopic niche resection became pregnant after surgery, the majority of them spontaneously. However, it is not known whether the chance of pregnancy really does improve after a laparoscopic niche resection in comparison with no surgery. This is because some women with a niche also achieve spontaneous pregnancy. After a laparoscopic niche resection the scar needs 6 months to recover and advice is not to get pregnant during this period. In other words, this surgery may delay the reproductive process.