CESAREAN SCAR ON THE UTERUS: INCIDENCE, CONSEQUENCES, AND RESTORATION METHODS

Аннотация

Cesarean section is one of the leading methods of delivery, with a global trend toward increasing frequency. According to statistical data, 15.2% to42% ofall deliveries are performed via cesarean section [1]. One of the significant complications following cesarean section is uterine scar insufficiency, which is particularly important when planning subsequent pregnancies. The risk of scar rupture, accompanied by life-threatening hemorrhage, ranges from 0.62% to9% [2]. Keywords: Cesarean section, uterine scar insufficiency, scar defect, niche, uterine rupture, myometrial thinning, postoperative complications, placenta accreta spectrum, adhesion process, ultrasound diagnostics, magnetic resonance imaging (MRI), reconstructive uterine surgery, obstetric outcomes, reproductivehealth, interpregnancy monitoring. Reconstructive uterine surgeries aim to restore the anatomical integrity of the myometrium and reduce the likelihood of complications in future pregnancies. In recent years, increasing attention has been paid to the diagnosis of scar conditions not only during pregnancy but also in the interpregnancy period. Modern diagnostic methods include the detection of scar defects (“niche”) usingultrasound and magneticresonance imaging (MRI) [3]. True uterine scar insufficiency may be associated with the formation of fistulous tracts due to impaired healing processes of the postoperative wound, which most commonly occurs withinthefirst 21days after surgery. Themain causes includepostoperative infection, the formation of hematomas between sutures, infiltrates, and abscesses [4]. Fistulas are most frequently detected in thecorners ofthepostoperative scar [5]. The diagnosis of uterine scar insufficiency requires a comprehensive approach, incorporating clinical data, ultrasound diagnostics, and, if necessary, endoscopic methods. Themanagement ofsuch patientsdepends ontheseverity ofthe scar defect and reproductive plans [6].