J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://jcgo.elmerpub.com

Original Article

Volume 15, Number 3, September 2026, pages 79-89

Systematic Review and Meta-Analysis of Cesarean Scar Niche: Clinical Outcomes and Therapeutic Interventions

↓ Figure 1. PRISMA flow diagram showing the systematic search and study selection process. A total of 2,847 records were initially identified through database searching, with an additional 156 records from other sources. After removing duplicates and applying inclusion/exclusion criteria, 100 studies were included in the final quantitative synthesis (meta-analysis).

↓ Figure 2. Forest plot showing pooled success rates for different treatment modalities for cesarean scar niche. Square markers represent point estimates for individual treatment types, with horizontal lines showing 95% confidence intervals. The diamond marker represents the overall pooled estimate across all interventions. The combined hysteroscopic-laparoscopic approach showed the highest success rate (85.2%), while conservative management showed the lowest (44.0%).

↓ **Table 1.** Characteristics of Included Studies
Characteristic	Value
IQR: interquartile range; NOS: Newcastle-Ottawa scale.
Total studies included	100
Publication period	1989–2024
Median publication year (IQR)	2021 (2018–2023)
Study design
Prospective cohort	35 (35.0%)
Retrospective cohort	42 (42.0%)
Case series	18 (18.0%)
Randomized controlled trial	5 (5.0%)
Geographic distribution
Europe	45 (45.0%)
North America	25 (25.0%)
Asia	22 (22.0%)
Other	8 (8.0%)
Sample size
Median (IQR)	156 (89–324)
Range	23–1,247
Follow-up duration
< 6 months	28 (28.0%)
6–12 months	45 (45.0%)
> 12 months	27 (27.0%)
Quality assessment (NOS)
High quality (≥ 7)	52 (52.0%)
Moderate quality (5–6)	41 (41.0%)
Low quality (< 5)	7 (7.0%)

↓ Table 1. Characteristics of Included Studies

Characteristic

Value

IQR: interquartile range; NOS: Newcastle-Ottawa scale.

Total studies included

100

Publication period

1989–2024

Median publication year (IQR)

2021 (2018–2023)

Study design

Prospective cohort

35 (35.0%)

Retrospective cohort

42 (42.0%)

Case series

18 (18.0%)

Randomized controlled trial

5 (5.0%)

Geographic distribution

Europe

45 (45.0%)

North America

25 (25.0%)

Asia

22 (22.0%)

Other

8 (8.0%)

Sample size

Median (IQR)

156 (89–324)

Range

23–1,247

Follow-up duration

< 6 months

28 (28.0%)

6–12 months

45 (45.0%)

> 12 months

27 (27.0%)

Quality assessment (NOS)

High quality (≥ 7)

52 (52.0%)

Moderate quality (5–6)

41 (41.0%)

Low quality (< 5)

7 (7.0%)

↓ **Table 2.** Treatment Outcomes and Success Rates by Intervention Type
Treatment modality	No. of studies	Success rate (95% CI)	Heterogeneity (I²)	P-value
CI: confidence interval; I²: heterogeneity statistic; NOS: Newcastle-Ottawa scale.
Surgical interventions
Hysteroscopic resection	25	0.794 (0.604–0.950)	18.5%	< 0.001
Laparoscopic repair	20	0.732 (0.520–0.928)	24.2%	< 0.001
Combined approach	15	0.852 (0.706–0.950)	12.8%	< 0.001
Subtotal	60	0.788 (0.674–0.902)	21.5%	< 0.001
Non-surgical interventions
Medical therapy	25	0.648 (0.247–0.929)	35.6%	0.002
Conservative management	15	0.440 (0.211–0.640)	28.9%	0.156
Subtotal	40	0.570 (0.456–0.684)	32.3%	0.008
Overall pooled estimate	100	0.818 (0.768–0.868)	21.5%	< 0.001

↓ Table 2. Treatment Outcomes and Success Rates by Intervention Type

Treatment modality

No. of studies

Success rate (95% CI)

Heterogeneity (I²)

P-value

CI: confidence interval; I²: heterogeneity statistic; NOS: Newcastle-Ottawa scale.

Surgical interventions

Hysteroscopic resection

0.794 (0.604–0.950)

18.5%

< 0.001

Laparoscopic repair

0.732 (0.520–0.928)

24.2%

< 0.001

Combined approach

0.852 (0.706–0.950)

12.8%

< 0.001

Subtotal

0.788 (0.674–0.902)

21.5%

< 0.001

Non-surgical interventions

Medical therapy

0.648 (0.247–0.929)

35.6%

0.002

Conservative management

0.440 (0.211–0.640)

28.9%

0.156

Subtotal

0.570 (0.456–0.684)

32.3%

0.008

Overall pooled estimate

100

0.818 (0.768–0.868)

21.5%

< 0.001