Incompetent uterine scar after caesarean section as a separate nosology

Torobaeva M.T.; Buyanova S.N.; Puchkova N.V.

doi:https://doi.org/10.17116/rosakush20232303119

Close metadata

Recommended articles:

Virus-associated progesterone-resistant chronic endometritis — the oncorisk situation?. Russian Bulletin of Obstetrician-Gynecologist. 2025;(1):25-30

Quality assessment of health care delivery to patients with sexually transmitted infections in dermatovenereological institutions of Moscow according to medical records analysis. Russian Journal of Clinical Dermatology and Venereology. 2024;(5):503-509

Difficulties in lifetime diagnosis of Creutzfeldt—Jakob disease. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):19-27

Clinical case of auricular gouty tophi. Russian Bulletin of Otorhinolaryngology. 2024;(6):80-84

Detection of mpox virus by enzyme immunoassay in a no-instrumental format and after its inactivation with formaldehyde. Molecular Genetics, Microbiology and Virology. 2024;(4):49-53

Laboratory diagnostics of monkeypox: basic methods and prospects for new developments. Laboratory Service. 2024;(4):57-64

Obstructive sleep apnea syndrome as a predictor of atrial fibrillation. Russian Journal of Preventive Medicine. 2025;(1):109-114

Results of the All-Russian consensus conference on complications in bariatric surgery. Endoscopic Surgery. 2025;(1):15-24

X-ray endoscopic classification of aspiration syndrome. Endoscopic Surgery. 2025;(1):31-37

Artificial Intelligence in Dentistry: A Sign of the Times. Stomatology. 2025;(1):87-92

Abstract:

An incompetent uterine scar after caesarean section is one of the actual problems of modern obstetrics. Global preoccupation with abdominal delivery is contributing to an increase of its «delayed» complications, such as an incompetent uterine scar. Since there is no tendency for abdominal delivery to become less frequent, the question of how to form a competent scar is still actual. The paper gives a review of the published data of the studies carried out by the Russian and foreign authors during the recent years.

Keywords:

incompetent uterine scar after cesarean section

niche

diagnosis and methods of treatment

Authors:

Torobaeva M.T.

Moscow Regional Research Institute of Obstetrics and Gynecology

ORCID: 0000-0002-8947-6325

Buyanova S.N.

Moscow Regional Research Institute of Obstetrics and Gynecology

ORCID: 0000-0002-1358-6640

Puchkova N.V.

Moscow Regional Research Institute of Obstetrics and Gynecology

ORCID: 0000-0002-4035-1716

Received:

30.06.2022

Accepted:

02.08.2022

Close metadata

References:

Zharkin NA, Logutova LS, Semikhova TG. Cesarean section: medical, social and moral-ethical problems. Rossiiskii vestnik akushera-ginekologa. 2019;19:4:5-10. (In Russ.). https://doi.org/10.17116/rosakush2019190415
Szafarowska M, Biela M, Wichowska J, Sobociński K, Segiet-Święcicka A, Doniec J, Kamiński P. Symptoms and quality of life changes after hysteroscopic treatment in patients with symptomatic isthmocele-preliminary results. J Clin Med. 2021;10:13:2928. https://doi.org/10.3390/jcm10132928
Poidevin LO. The value of hysterography in the prediction of cesarean section wound defects. Am J Obstet Gynecol. 1961;81:67-71. https://doi.org/10.1016/s0002-9378(16)36308-6
Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril. 2020;113:4:704-716. https://doi.org/10.1016/j.fertnstert.2020.01.037
Shao MJ, Hu M. A growing concern: cesarean scar defect and massive uterine bleeding. J Clin Case Rep. 2015;5:9:599-600.
Lisitsyna OI, Shmakov RG. Nishi uterine scar after cesarean section: diagnosis, treatment and outcomes. Akusherstvo i ginekologiya. 2019;9:24-31. (In Russ.).
Antila-Långsjö RM, Mäenpää JU, Huhtala HS, Tomás EI, Staff SM. Cesarean scar defect: a prospective study on risk factors. Am J Obstet Gynecol. 2018;219:5:458.e1-458.e8.
Buyanova SN, Senchakova TN, Shchukina NA. Diagnosis, treatment and prevention of delayed complications of cesarean section. Vestnik Rossiiskoi assotsiatsii akusherov-ginekologov. 1997;1:65-69. (In Russ.).
Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol. 1995;14:1:16-20.
Tsuji S, Takahashi A, Higuchi A, Yamanaka A, Amano T, Kimura F, Seko-Nitta A, Murakami T. Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome. PLoS One. 2020;15:12:0243421.
Warshafsky C, Chaikof M, AP Sanders, Murji A, Sobel M, Hartman A, Huszti E, Li Q, Stere A. Preventing Isthmocele after Cesarean Section (PICS): A Pilot Randomized Controlled Trial. J Minimal Invas Gynecol. 2021;28:11:73-74.
Ruz Barros, Rodrigo Emilio, Gallardo Valencia, Luis Ernesto, Cortés Algara, Alfredo Leonardo, Leroy López, Lionel, Espinoza Rojas, Elizabeth Patricia, Ali Quispe, Elvira, Ayala Quispe, Vianey Brigida, & Ortega Vargas, Annabel. Istmocele: ¿cuál es la mejor vía para su abordaje? Acta médica Grupo Ángeles. 2018;16:2:152-155.
Torre A, Verspyck E, Hamamah S, Thomassin I, Thornton J, Fauconnier A, Crochet P. Isthmocèle: définition, diagnostic, facteurs de risque, prévention, symptômes, complications, et traitements. Cesarean scare niche: Definition, diagnosis, risk factors, prevention, symptoms, adverse effects, and treatments. Gynecol Obstet Fertil Senol. 2021;49:11:858-868. https://doi.org/10.1016/j.gofs.2021.06.003
Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean Niche (Isthmocele) in uterine scar: an update. J Obstet Gynaecol India. 2020;70:6:440-446. https://doi.org/10.1007/s13224-020-01370-0
Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, Nappi L, Greco P, Scutiero G. Isthmocele: from risk factors to management. RBGO Gynecol Obstet. 2019;41:1:44-152.
Martynov SA, Adamyan LV. Cesarean scar defect: terminological aspects. Gynekologiya. 2020;22:5:70-75. (In Russ.).
Nozhnitseva ON, Semenov IA, Bezhenar’ VF. The scar on the uterus after cesarean section and the optimal algorithm for diagnostics. Luchevaya diagnostika i terapiya. 2019;2:85-90. (In Russ). https://doi.org/10.22328/2079-5343-2019-10-2-85-90
Buyanova SN, Shchukina NA, Puchkova NV. Specific features of the clinical course of endomyometritis after cesarean section and its outcomes. Rossiiskii vestnik akushera-ginekologa. 2012;12:5:84-88. (In Russ.).
Buyanova SN, Shchukina NA, Mgeliashvili MV, Babunashvili EL, Puchkova NV, Petrakova SA, Yudina NV, Gukasyan SA, Ermolaeva EE, Budykina TS, Sidorkina MI, Barinova IV, Chechneva MA, Rizhinashvili ID, Stotskaya TV, Timofeeva ES, Barto RA, Zemskova NYu. Clinical, laboratory and instrumental criteria of factors and risks of formation and diagnosis of an untenable scar on the uterus after cesarean section. Possibilities of reconstructive operations in the early, late postoperative and delayed periods (at the stage of pre-gravidar preparation). A manual for physicians. MAXS Press; 2018;24. (In Russ.).
Krasnopol’skii VI, Logutova LS, Buyanova SN. Unstable uterine scar after cesarean section: causes of formation and treatment tactics. Akusherstvo i ginekologiya. 2013;12:28-33. (In Russ.).
Zheng X, Yan J, Liu Z, Wang X, Xu R, Li L, Lin Z, Zheng L, Liu M, Chen Y. Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum. J Intern Med Re. 2020;48:9. https://doi.org/10.1177/0300060520954993
Park IY, Kim MR, Lee HN, Gen Y, Kim MJ. Risk factors for Korean women to develop an isthmocele after a Cesarean section. BMC Pregnancy Childbirth. 2018;18:1:162.
Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30:12:2695-2702.
Rosa F, Perugin G, Schettini D, Romano N, Romeo S, Podestà R, Guastavino A, Casaleggio A, Gandolfo N. Imaging findings of cesarean delivery complications: cesarean scar disease and much more. Insights Imaging. 2019;10;98.
Eremkina VI, Garifullova YuV. Reconstructive and reconstructive plasty of an incompetent uterine scar by vaginal access outside of pregnancy. Prakticheskaya meditsina. 2014;4:46-48. (In Russ.).
Khasanov AA, Zhuravleva VI, Galautdinova DI. Long-term outcomes of reconstructive plasty of incompetent uterine scar by vaginal access. Prakticheskaya meditsina. 2017;109:8:168-170. (In Russ.).
Krasnopol’skii VI, Logutova LS, Buyanova SN, Chechneva MA, Akhvlediani KN. Results of operative obstetrical activity in modern obstetrics. Zhurnal akusherstva i zhenskikh bolesnei. 2015;64:2:53-58. (In Russ.).
Ectopic pregnancy: Clinical recommendations (protocol of treatment). Approved by the Russian Society of obstetricians and gynecologists with the Ministry of Health of Russia of Yuly 6, 2017; 15(4/10/2):729-735. (In Russ.).
Buyanova SN, Shchukina NA, Chechneva MA, Puchkova NV, Zemskova NYu, Torobaeva MT. Pregnancy in the scar after cesarean section: the possibility of surgical correction. Rossiiskii vestnik akushera-ginekologa. 2020;20:6:65-70. (In Russ.). https://doi.org/10.17116/rosakush20202006165
Darwish HS, Habash YH, Habash MY. Ectopic pregnancies in caesarean section scars: 5 years experience. Clin Imag. 2020;66:26-34. https://doi.org/10.1016/j.clinimag.2020.04.037
Fedorov AA, Popov AA, Chechneva MA, Logutova LS, Shchukina NA, Vrotskaya VS, Koval’ AA, Tyurina SS, Efremova ES, Bespalova AG. Niche in the uterine scar after cesarean section. Diagnostics, surgical tactics and outcomes. Rossiiskii vestnik akushera-ginekologa. 2021;21:2:50-55. (In Russ.). https://doi.org/10.17116/rosakush20212102150
Krasnopol’skii VI, Buyanova SN, Shchukina NA, Logutova LS. Uterine suture (scar) incompetence after cesarean section: Problems and solutions (an editorial). Rossiiskii vestnik akushera-ginekologa. 2015;15:3:4-8. (In Russ.). https://doi.org/10.17116/rosakush20151534-8
Buyanova SN, Shchukina NA, Chechneva MA, Mgeliashvili MV, Titchenko YuP, Puchkova NV, Barto RA. Current diagnostic techniques for inconsistent uterine sutures or scar after cesarean section. Rossiiskii vestnik akushera-ginekologa. 2013;13:1:73-77. (In Russ.).
Chechneva MA, Titchenko LI, Buyanova SN, Puchkova NV. Ultrasound diagnosis of an incompetent uterine scar in the remote postoperative period. SonoAce Ultrasound. 2011;22:35-39. (In Russ.).
Buyanova SN, Shchukina NA, Logutova LS, Puchkova NV, Chechneva MA, Barto RA, Blagina EI. Diagnosis and management tactics in patients with an incompetent uterine scar after cesarean section at the stage of pregnancy planning. Rossiiskii vestnik akushera-ginekologa. 2015;15:5:82-88. (In Russ.). https://doi.org/10.17116/rosakush201515482-88
Krasnopol’skaya KV, Popov AA, Chechneva MA, Fedorov AA, Ershova IYu. Preconceptional methroplastic operation in patients with uterine scar incompetence after Caesarian section: the influence on natural fertility and IVF outcomes. Problemy reproduktsii. 2015;21:3:56-62. (In Russ.). https://doi.org/10.17116/repro201521356-62
Zeller A, Villette C, Fernandez H, Capmas P. Is hysteroscopy a good option to manage severe cesarean scar defect? J Minim Invasive Gynecol. 2020;28:7:1397-11402. https://doi.org/10.1016/j.jmig.2020.11.005
Bandry K, Abou-Taleb Hisham & Seifeldein, Gehan & Taha, Mohamad & Qenawy Omran. Prediction of the relationship of cesarean section scar niche and postmenstrual spotting: is there any relation? Egyptian J Radiol Nuclear Med. 2022;53. https://doi.org/10.1186/s43055-022-00699-y
Pirtea L, Balint O, Secoşan C, Grigoraş D, Pirtea P. Case Report: Laparoscopic Isthmocele Repair on an 8 Weeks Pregnant Uterus. Frontiers in Medicine (Lausanne). 2022;9:831588. https://doi.org/10.3389/fmed.2022.831588
Vikhareva O, Rickle GS, Lavesson T, Nedopekina E, Brandell K, Salvesen KÅ. Hysterotomy level at Cesarean section and occurrence of large scar defects: a randomized single-blind trial. Ultrasound Obstet Gynecol. 2019;53:4:438-442. https://doi.org/10.1002/uog.20184
Gurbuz AS, Gode F, Ozcimen N. Non-Invasive isthmocele treatment: a new therapeutic option during assisted reproductive technology cycles? J Clin Med Res. 2020;12:5:307-314. https://doi.org/10.14740/jocmr4140
López-Torres L, Quirós-Sánchez J, Serna-Hoyos L, López-Restrepo M, Echavarría-Restrepo L, Campo-Campo M, Cuesta-Castro D. Clinical and ultrasonographic presentation of isthmocele in patients with previous cesarean section. Cuban J Obstet Gynecol. 2021;46:3.
Kafkasli A, Franklin RR, Sauls D. Endometriosis in the uterine wall cesarean section scar. Gynecol Obstet Invest. 1996;42:3:211-213.
Isci H, Gonenc G, Yigiter AB, Guducu N, Dünder I. Intrauterine endometriotic cyst at the site of previous cesarean scar; scar endometriosis. Clin Exp Obstet Gynecol. 2015;42:1:106-107.
Dobrosz Z, Paleń P, Stojko R, Właszczuk P, Niesłuchowska-Hoxha A, Piechuta-Kośmider I. Clear cell carcinoma derived from an endometriosis focus in a scar after a caesarean section — a case report and literature review. Ginekol Pol. 2014;85:10:792-795.
Thurmond AS, Harvey WJ, Smith SA. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 1999;18:13-16.
Shao MJ, Hu M. A growing concern: cesarean scar defect and massive uterine bleeding. J Clin Case Rep. 2015;5:9:599-600.
Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013;20:05:562-572. https://doi.org/10.1016/j.jmig.2013.03.008
Wang J, Pang Q, Wei W, Cheng L, Huang F, Cao Y, Hu M, Yan S, He Y, Wei Z. Definition of large niche after Cesarean section based on prediction of postmenstrual spotting: Chinese cohort study in non-pregnant women. Ultrasound Obstet Gynecol. 2022:59:450-456. https://doi.org/10.1002/uog.24817
Tanimura S, Funamoto H, Hosono T, Shitano Y, Nakashima M, Ametani Y, Nakano T. New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect. J Obstet Gynecol Res. 2015;41:9:1363-1369.
Stegwee SI, Beij A, de Leeuw RA, Mokkink LB, van der Voet LF, Huirne JAF. Niche-related outcomes after Caesarean section and quality of life: a focus group study and review of literature. Qual Life Res. 2020;29:4:1013-1025. https://doi.org/10.1007/s11136-019-02376-6
Bij de Vaate AJM, Brölmann HAM, van der Voet LF, van der Slikke JW, Veersema S. and Huirne JAF. Ultrasound evaluation of the Caesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011;37:93-99. https://doi.org/10.1002/uog.8864
Jordans IPM, Leeuw RA, Stegwee SI, Amso NN, Barri-Soldevila PN, van den Bosch T, Bourne T, Brölmann HAM, Donnez O, Dueholm M, Hehenkamp WJK, Jastrow N, Jurkovic D, Mashiach R, Naji O, Streuli I, Timmerman D, van der Voet LF, Huirne JAF. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. JOURNAL CLUB. 2018;53:Issue 3:107-115.
AbdullGaffar B, Almulla A. A Histopathologic approach to uterine niche: what to expect and to report in hysteroscopy-resected isthmocele specimens. Int J Surg Pathol. 2022;30:3:240-250. https://doi.org/10.1177/10668969211039415
Zemskova NYu, Chechneva MA, Petrukhin VA, Lukashenko SYu. Ultrasound examination of the uterine scar after cesarean section in predicting the outcome of pregnancy. Akusherstvo i ginekologiya. 2020;10:99-104. (In Russ.).