V.F. NESTEROV, G.B. MALGINA, A.A. MIKHELSON, D.V. POGORELKO, A.G. SYCHUGOV

 Ural Scientific Research Institute for Protection of Maternity and Childhood, Yekaterinburg

 Contact details:

Nesterov V.F. — PhD (Medicine), Senior Researcher, Head of the Maternity Department

Address: 1 Repin St., 620028 Yekaterinburg, Russian Federation, tel.: +7-912-24-60-260, e-mail: dr.nesterov2014@yandex.ru

 Pre-gravidar metroplasty is currently the main method of correcting an incomplete scar on the uterus from cesarean section surgery.

The purpose — to analyze the reproductive outcomes, features of the pregnancy course and delivery of patients after metroplasty performed outside pregnancy for the incompleteness/insolvency of the scar on the uterus.

Material and methods. A two-stage cohort retrospective study was conducted. At the first stage, the anamnesis, indications for laparoscopic metroplasty, and histological features of scars were studied in 186 patients (main group 1) who underwent metroplasty for an incomplete scar on the uterus outside pregnancy. At the second stage, a comparative study was conducted, which included 77 pregnant women divided into 2 groups. The main group 2 included 35 pregnant women after laparoscopic metroplasty performed outside pregnancy. The comparison group consisted of 42 pregnant women with an incomplete scar on the uterus, detected during abdominal delivery and confirmed histologically. Histological examination of excised uterine scar tissue was performed in both groups.

Results. The features of the formation of scar incompleteness/insolvency depend more on the initial characteristics of the patient’s body than on the number of operations performed. When analyzing the indications for the first CS in the studied groups, it was revealed that in the main group, the first cesarean section was statistically significantly more often performed due to labor anomalies or early preterm birth. In the main group, 6/35 (17.1%) patients had a scar identified as defective. The main macroscopic changes were a thinning of the scar zone on the uterus in 4/35 (11.4%) cases; areas of retractions and a pronounced vascular pattern with large-diameter vessels were detected in 3/35 (8.5%) patients. Thus, the risk of developing disability during subsequent pregnancy in patients who underwent metroplasty significantly decreases (OR 0.54, CI 95% (0.43; 0.68)).

Conclusion. Metroplasty of an incomplete scar at the intergravidar stage significantly reduces the risk of its incompleteness during subsequent pregnancy.

Key words: uterine scar, metroplasty, pregnancy, childbirth, morphological examination of the scar.

REFERENCES

1. Shmakov R.G., Novikova S.V., Il′yashenko E.N., Logutova L.S. Caesarean section in modern obstetrics: problems and ways to overcome them. Rossiyskiy vestnik akushera-ginekologa, 2025, vol. 25, no. 4, pp. 5–18 (in Russ.). DOI: 10.17116/rosakush2025250415
2. Ishan-Khodzhayeva F.R. Features of abdominal delivery in premature births in a level 3 hospital in Dushanbe. Doktor.Ru, 2022, vol. 21, no. 5, pp. 62–66 (in Russ.). DOI: 10.31550/1727-2378-2022-21-5-62-66
3. Vuchenovich Yu.D., Novikova V.A., Kostin I.N., Radzinskiy V.E. Risks of scar failure and attempts at vaginal delivery after cesarean section. Akusherstvo i ginekologiya: novosti, mneniya, obucheniye, 2019, no. 7 (3. Prilozheniye), pp. 93–100 (in Russ.). DOI: 10.24411/2303-9698-2019-13913
4. Nesterov V.F., Mal′gina G.B., D′yakova M.M., Grishkina A.A. Clinical and morphological variants of incomplete uterine scar after cesarean section. Akusherstvo i ginekologiya, 2025, no. 10, pp. 62–72 (in Russ.). DOI: 10.18565/aig.2025.197
5. Mudrov V.A., Mochalova M.N., Mudrov A.A. Features of delivery of pregnant women with a scar on the uterus through the natural birth canal at the present stage. Zhurnal akusherstva i zhenskikh bolezney, 2018, vol. 67, no. 1, pp. 26–37 (in Russ.). DOI: 10.17816/JOWD67126-37
6. Buyanova S.N., Shchukina N.A., Logutova L.S., Puchkova N.V., Chechneva M.A., Barto R.A., Blagina E.I. Diagnosis and management tactics for patients with an incompetent uterine scar after cesarean section at the stage of pregnancy planning. Rossiyskiy vestnik akushera-ginekologa, 2015, vol. 15, no. 5, pp. 82–88 (in Russ.). DOI: 10.17116/rosakush201515482-88
7. Park I.Y., Kim M.R., Lee H.N., Gen Y., Kim M.J. Risk factors for Korean women to develop an isthmocele after a cesarean section. BMC Pregnancy Childbirth, 2018, vol. 18 (1), p. 162. DOI: 10.1186/s12884-018-1821-2.
8. Torobayeva M.T., Buyanova S.N., Puchkova N.V. Incompetent scar on the uterus after cesarean section as a separate nosology. Rossiyskiy vestnik akushera-ginekologa, 2023, vol. 23, no. 3, pp. 19–28 (in Russ.). DOI: 10.17116/rosakush20232303119
9. Martynov S.A. Scar defect on the uterus after cesarean section: diagnosis and treatment outside pregnancy. Ginekologiya, 2020, vol. 22, no. 3, pp. 6–10 (in Russ.). DOI: 10.17116/repro201521356-62
10. Pirtea L., Balint O., Secoşan C., Grigoraş D., Pirtea P. Case Report: laparoscopic isthmocele repair on an 8 weeks pregnant uterus. Front. Med. (Lausanne), 2022, vol. 9. 831588. DOI: 10.3389/fmed.2022.831588
11. Krasnopol′skaya K.V., Popov A.A., Chechneva M.A., Fedorov A.A., Yershova I.Yu. Pregravid metroplasty for incompetent uterine scar after cesarean section: impact on natural fertility and IVF results. Problemy reproduktsii, 2015, vol. 21, no. 3, pp. 56–62 (in Russ.). DOI: 10.17116/repro201521356-62
12. Zharkin N.A., Logutova L.S., Semikhova T.G. Caesarean section: medical, social, and moral-ethical issues. Rossiyskiy vestnik akushera-ginekologa, 2019, vol. 19, no. 4, pp. 5–10 (in Russ.). DOI: 10.17116/rosakush2019190415
13. De Luget C.D., Becchis E., Fernandez H., Donnez O., Quarello E. Can uterine niche be prevented? J Gynecol. Obstet. Hum. Reprod, 2022, vol. 51 (3). 102299. DOI: 10.1016/j.jogoh.2021.102299
14. Kostina E.A., Shatunova E.P., Lineva O.I. Clinical features of the course of pregnancy in women with a scar on the uterus due to connective tissue dysplasia. Prakticheskaya meditsina, 2022, vol. 20, no. 3, pp. 74–78 (in Russ.). https://doi.org/10.32000/2072-1757-2022-3-74-78
15. Karavayev Yu.N., Arslanyan K.N., Loginova O.N. Features of the course of pregnancy and childbirth in patients with a scar on the uterus after reconstructive and plastic surgeries performed through different approaches. Lechashchiy vrach, 2019, no. 8, pp. 68–71 (in Russ.). DOI: 10.26295/OS.2019.78.78.013
16. Mikheyeva A.A., Yarygina T.A., Shmakov R.G., Kostyukov K.V., Rogachevskiy O.V., Pyregov A.V. Ultrasound criteria of a scar on the uterus after metroplasty with placenta accreta and the use of platelet-rich plasma. Akusherstvo i ginekologiya, 2023, no. 3, pp. 41–50 (in Russ.). DOI: 10.18565/aig.2023.19
17. Bij de Vaate A.J., van der Voet L.F., Naji O., Witmer M., Veersema S., Brolmann H.A. et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet. Gynecol, 2014, vol. 43 (4), pp. 372–382. DOI: 10.1002/uog.13199
18. Barinov S.V., Tirskaya Yu.I., Kadtsyna T.V., Lazareva O.V., Chulovskiy Yu.I., Kovaleva Yu.A. et al. Delivery of a pregnant woman with placenta accreta and a uterine scar after cesarean section with placental hernia formation. Clinical observation. Akusherstvo i ginekologiya, 2020, no. 6, pp. 141–146 (in Russ.). DOI: 10.18565/aig.2020.6.141-146
19. D’Antonio F., Palacios-Jaraguemada J., Lim P.S., Forlani F., Lanzone A., Timor-Tritsch I., Cali G. Counseling in fetal medicine: evidence-based answers to clinical questions on morbidly adherent placenta. Ultrasound Obstet. Gynecol, 2016, vol. 47 (3), pp. 290–301. DOI: 10.1002/uog.14950
20. Yametova N.M., Tskhay V.B., Brekhova I.S., Yametov P.K., Domracheva M.Ya., Grebennikova E.K. Features of the course of pregnancy and childbirth in women operated on for uterine scar failure after cesarean section. Sibirskoye meditsinskoye obozreniye, 2025, no. 1, pp. 64–70 (in Russ.). DOI: 10.20333/25000136-2025-1-64-70
21. Dominguez J.A., Pacheco L.A., Moratalla E., Carugno J.A., Carrera M., Perez-Milan F. et al. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound in obstetrics and gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2023, vol. 62 (3), pp. 336–344. DOI: 21.https://10.1002/uog.26171
22. Kurochka M.P., Pelogeina E.I., Zabozlayev F.G., Markina V.V. Clinical and anamnestic risk factors for the formation of an incompetent scar after one cesarean section. Meditsinskiy vestnik Yuga Rossii, 2025, vol. 16, no. 2, pp. 29–36 (in Russ.). DOI: 10.21886/2219-8075-2025-16-2-29-36
23. Posleoperatsionnyy rubets na matke. Klinicheskiye rekomendatsii MZ RF, 2024 [Postoperative scar on the uterus. Clinical guidelines of the Ministry of Health of the Russian Federation, 2024].
24. Tskhay V.B. Endometriosis of an incompetent scar on the uterus after cesarean section. Akusherstvo i ginekologiya, 2016, no. 8, pp. 119–123 (in Russ.). DOI: 10.18565/aig.2016.8.119-123
25. Glukhov E.Yu., Dikke G.B., Neff E.I., Glukhova V.E., Svyazhina A.V. Chronic endometritis and incompetent uterine scar after cesarean section: long-term results of metroplasty. Akusherstvo i ginekologiya, 2019, no. 2, pp. 126–134 (in Russ.). DOI: 10.18565/aig.2019.2.126-134