CLINICAL AND SONOGRAPHIC MARKERS OF POSTOPERATIVE UTERINE SCAR DEFECT: ASSESSMENT IN THE INTERGENETIC INTERVAL
DOI:
https://doi.org/10.11603/24116-4944.2025.2.15793Keywords:
uterine scar defect, isthmocele, cesarean section, ultrasound examination, residual myometrial thickness, sonoelastometry, pregnancy complicationsAbstract
The aim of the study – to develop an algorithm of sonographic diagnostics of local thinning of the uterine scar outside pregnancy and to present the possibility of using the values of the residual myometrial thickness to predict the presence of a «niche» and to develop screening programs.
Materials and Methods. Three study groups were formed: the first group included 60 patients with abdominal delivery in history with the symptom complex of the “operated uterus”; the second group – 60 patients with cesarean section in history and without characteristic pathological symptoms; the control group – 30 conditionally healthy patients who underwent planned pregravid preparation for future pregnancy. Transvaginal ultrasound scanning was performed, Doppler assessment of uterine vessels and tissue perfusion in the area of the postoperative scar, and compression sonoelastography was used.
Results and Discussion. The obtained statistical calculations made it possible to identify predictors appropriate for forming risk groups of patients in whom a careful evaluation of the postoperative uterine scar at the preconceptional stage is necessary: obesity (OR=2.51), metabolic disorders (diabetes mellitus, thyroid disorders) (OR=3.25), the number of Cesarean sections (>2 CS) (OR=2.85), uterine adenomyosis, external endometriosis (OR=3.51), the symptom complex of the “operated uterus” (OR=17.96), and also visualization of the “niche” (OR=11.67). Ultrasound assessment made it possible to present the parameters of residual myometrial thickness >3 mm in the first group – in 19 (38.0 %) sonograms out of 50 cases, and in the second group – in 13 observations (72.2 %) out of 18 episodes of thinning of the postoperative scar. It is worth noting additional sonographic criteria of scar insufficiency on the uterus, first of all in patients of the first group, among which we should note: deformation of the external uterine contour – in 11 cases (22.0 %), thinning of the myometrium at its apex <2.0 mm – in 6 sonograms (12.0 %), impaired perfusion of blood supply in the area of the scar – in 21 observations (42.0 %), fluid inclusions (small cysts) – in 17 sonograms (34.0 %).
Conclusions. Careful assessment of the scar area with the use of sonography, Doppler assessment and elastometry allows a detailed evaluation of the area of the postoperative scar and, at the stage of pregravid preparation, to identify the main markers of predicting the probability of obstetric complications. With visualization of the residual myometrial thickness <3 mm, especially when combined with additional signs of scar insufficiency (deformation of the external uterine contour, thinning of the myometrium at its apex <2.0 mm, impaired perfusion of blood supply in the scar area, fluid inclusions), the risk of preterm birth increases
4.3 times, low placentation and placenta previa – 4.8 times, placenta accreta spectrum in the scar area, and the risk of uterine hemorrhage – 13.6 times.
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Accepted 2025-12-31
Published 2025-12-15
