Impact of a Bladder Flap on Cesarean Scar Niche Development

The goal of this trial is to examine if the completion or omission of a bladder flap impacts the location and formation of cesarean scar niche in women undergoing primary cesarean section. The main question it aims to answer is if omission of a bladder flap changes the prevalence of cesarean scar niche on a 6-8 week postpartum ultrasound. Researchers will compare participants that have a bladder flap made to those that have a bladder flap omitted at time of their primary cesarean delivery. Participants will have routine postpartum care and be asked to return for a 6-8 week postpartum transvaginal ultrasound.

Inclusion Criteria: * Age 18 years or older * Primary low transverse cesarean section performed at Montefiore Weiler or Wakefield Hospitals * Able to provide informed consent in English or Spanish * Plan for postpartum care at Montefiore Medical Center Exclusion Criteria: * History of a prior uterine surgery * Known congenital uterine anomalies * Inability to safely access lower uterine segment at time of delivery * Hysterotomy is extended past/outside the lower uterine segment at time of surgery * Hysterectomy is indicated prior to postpartum follow-up