American Journal of Obstetrics and Gynecology
Images in gynecologyFinding a niche: Magnetic resonance imaging located an often-overlooked source of uterine bleeding
Section snippets
Case notes
Six months after an uncomplicated cesarean delivery, a 28-year-old woman presented with intermenstrual bleeding and left-sided pelvic pain. The abnormal uterine bleeding, dark red and brown in color, began 3 months after delivery. It started approximately 1 week after the last day of her menstrual cycle, lasted for 2-3 days, and required the use of 2-3 tampons per day. She had resumed taking oral contraceptives 2 months after the birth of her child. A physical examination was unremarkable, and
Conclusions
MRI illustrated a niche at the site of the cesarean scar. This depression retained menstrual blood products, which were the source of the patient's abnormal bleeding. After reassurance that her bleeding was not due to a critical pathologic condition, she was comfortable with no treatment.
A niche, classically described as a sonographic finding, is a reservoir that forms in the region of a prior cesarean scar.1 Blood may accumulate within the niche due to impaired drainage resulting from
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Cited by (0)
The authors report no conflict of interest.
Cite this article as: Reiter M, Schwope R. Finding a niche: magnetic resonance imaging located an often-overlooked source of uterine bleeding. Am J Obstet Gynecol 2014;210:171.e1-2.