Abstract：
The increase in caesarean sections (CS) has resulted in an increase in women with a uterine niche. The exact aetiology of niche development has yet to be elucidated but is likely multifactorial. This study aimed to give a systematic overview of the available literature on histopathological features, risk factors and results of preventive strategies on niche development to gain more insight into the underlying mechanisms. Based on current published data histopathological findings associated with niche development were necrosis, fibrosis, inflammation, adenomyosis and insufficient approximation. Patient-related risk factors included multiple CS, BMI and smoking. Labour-related factors were CS before onset of labour, extended cervical dilatation, premature rupture of membranes and presenting part of the fetus at CS below the pelvic inlet. Preventive strategies should focus on the optimal level of incision, training of surgeons and full-thickness closure of the myometrium (single or double-layer) using non-locking sutures. Conflicting data exist concerning the effect of endometrial inclusion. Future studies without heterogeneity in population, using standardized performance of the CS after proper training and using standardized niche evaluation with a relevant core outcome set are required to allow meta-analyses and to develop evidence-based preventive strategies. These studies are needed to reduce the prevalence of niches and prevent complications in subsequent pregnancies such as caesarean scar pregnancies.
摘要：
剖腹产（CS）的增加导致子宫利基的女性增加。生态位发育的确切病因尚未阐明，但可能是多因素的。本研究旨在对组织病理学特征的现有文献进行系统概述，生态位发展的风险因素和预防策略的结果，以更深入地了解潜在的机制。根据目前发表的数据，与生态位发育相关的组织病理学发现是坏死，纤维化，炎症,子宫腺肌病和不够接近。患者相关的危险因素包括多个CS，BMI与吸烟与劳动相关的因素是分娩前的CS，宫颈扩张延长，胎膜早破，并在骨盆入口下方的CS处出现部分胎儿。预防策略应侧重于切口的最佳水平，外科医生的培训和使用非锁定缝线的子宫肌层全层闭合（单层或双层）。关于子宫内膜包合的影响存在矛盾的数据。未来在人群中没有异质性的研究，需要在适当的培训后使用CS的标准化性能，并使用具有相关核心结果集的标准化利基评估，以进行荟萃分析并制定基于证据的预防策略。需要进行这些研究以减少壁龛的患病率，并防止后续妊娠中的并发症，例如剖腹产疤痕妊娠。
