Cesarean scar disorder: International study defines new clinical condition

Amsterdam UMC | 03-29-2023
Cesarean section delivery
Cesarean scar disorder: International study defines new clinical condition Credit: © mvaligursky – Depositphotos

More than 30% of women who give birth by cesarean section suffer from long-term symptoms, such as abdominal pain, blood loss or fertility problems. These symptoms are caused by an abnormal uterine scar. This condition is defined now for the first time, thanks to an international study led by Amsterdam UMC, as Cesarean Scar Disorder (CSDi). This gives women recognition for these problems after a cesarean section. In addition, international studies on CSDi can now be better compared with each other, providing more insight into treatment options. The research is published today in JAMA Network Open.

In the Netherlands, more than 30,000 women receive a cesarean section every year. Almost 60% of them develop a “niche”, the name for a defect in the uterine wall caused by impaired healing. From the 18,000 with a niche, up to 10,000 women develop further symptoms or fertility problems. Amsterdam UMC, the Dutch expertise center for the treatment of niches, conducted research into these symptoms together with international expertise centers. Until now, there was no uniform definition for a condition that grouped these symptoms. This made the comparison of research impossible while also leaving those with the condition in the dark.

International consensus  

Medical researcher Saskia Klein Meuleman, together with gynecologists Robert de Leeuw and Judith Huirne, studied relevant literature and designed a study to develop a uniform definition for niche-related problems. In total 31 international experts from the USA to China, participated in this study.  All respondents treated at least 50 women a year with symptoms that fit the condition as well as published research on the subject. They agreed on the symptoms that can be caused by a cesarean scar, the aspects that make up the condition as well as the factors that can play a role. This created a clear picture of the condition, built on an international consensus. “We have also presented the final clinical picture to women with these symptoms. They recognized their own experiences and didn’t have anything to add,” says Klein Meuleman.

Looking for the best treatment  

Thanks to this research, women can receive an accurate diagnosis and it is thus easier to gain access to appropriate treatment. Women can also be better informed about the possible long-term complications of a cesarean section. “A cesarean section is a very important, and often life-saving, procedure. But it is important that we do not underestimate the effect this operation can have on the long-term quality of life,” adds Klein Meuleman.

Women should be informed about CSDi before undergoing a cesarean section so that they can, if possible, factor this into their decision-making process. Thanks to this information, they can also seek help faster if these symptoms occur.


Materials provided by Amsterdam University Medical Centers. Content may be edited for clarity, style, and length.


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