Sonographic Assessment of Cesarean Scars: Predicting Risks and Improving Outcomes

Abstract

Introduction: Cesarean section (CS) scars are recognized as potential sites of uterine weakness, which may contribute to significant obstetric complications in subsequent pregnancies, such as uterine rupture, dehiscence, or abnormal placental implantation. Timely and accurate evaluation of scar integrity is essential to predict these risks and ensure appropriate clinical management. Aim: This study aimed to evaluate the effectiveness of transvaginal ultrasound (TVS) in detecting cesarean scars, estimating the prevalence of scar defects, and assessing their size and anatomical location. Materials and Method: A prospective observational study was conducted over six months involving 182 postpartum women. Participants included 70 women with one prior CS, 32 with two CSs, 10 with three or more CSs, and 70 primiparous women who had delivered vaginally, serving as the control group. All subjects underwent TVS between 6 to 9 months following delivery. Sonographic parameters assessed included scar visibility, myometrial thickness at the uterine isthmus, and the presence, size, and position of any scar defects. Results: TVS successfully identified uterine scars in all women with a history of CS and none in the control group. A significant decline in median myometrial thickness was observed with increasing number of CSs: 8.4 mm after one, 6.6 mm after two, and 4.5 mm after three or more, compared to 11.5 mm following vaginal delivery (P < 0.001). Additionally, the prevalence and severity of scar defects were significantly higher among women with multiple CSs (P = 0.003).Conclusion: Transvaginal ultrasound is a reliable tool for cesarean scar assessment. Increased cesarean deliveries are associated with progressive myometrial thinning and a greater incidence of significant scar defects, underscoring the need for routine postpartum imaging in these patients.