Clinical Consensus No. 463: Diagnosis and Management of Cesarean Scar Niche.

Objective: This consensus statement aims to guide clinicians in the diagnosis, management and prevention of cesarean scar niche.

Target population: Patients undergoing cesarean delivery or patients with cesarean scar disorder.

Options: Options for management include expectant, medical and surgical management. These will depend on symptoms, residual myometrial thickness, and future fertility plans.

Outcomes: Outcomes include resolution of symptoms, repair of defect and subsequent successful pregnancy.

Benefits, harms, and costs: This guideline aims to benefit patients undergoing cesarean delivery or those suffering from cesarean scar disorder and to offer healthcare providers an evidence-based approach to the prevention, diagnosis and management of cesarean scar defects.

Evidence: Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified between January 1^st, 2005 and April 30^th, 2025 using the search terms "cesarean scar niche", "cesarean scar defect", and "isthmocele". Results were restricted to studies written in English.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A.

Intended audience: All health care providers who perform cesarean delivery or who care for patients who have previously undergone a cesarean delivery and may be experiencing symptoms of cesarean scar disorder, including obstetrician gynaecologists, family physicians, registered nurses, nurse practitioners and radiologists.

Tweetable abstract: Cesarean scar niche is a common consequence of cesarean delivery. Symptomatic patients suffering from cesarean scar disorder can be treated expectantly or with medical or surgical options. Asymptomatic patients do not require treatment.