Clinical and morphological variants of insufficient uterine scar after cesarean section

DOI

https://dx.doi.org/10.18565/aig.2025.197

Nesterov V.F., Malgina G.B., Dyakova M.M., Grishkina A.A.
1) Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia; 2) Sverdlovsk Regional Bureau of Anatomical Pathology, Yekaterinburg, Russia

Objective: To explore the morphological features and clinical manifestations of insufficient uterine scar after cesarean section.
Materials and methods: The study included 109 patients with uterine scar after cesarean section. They were divided into four groups depending on the clinical and morphological features of insufficient uterine scar: group I – “vascular”type (n=23), group II – “connective tissue” type (n=39); III – “inflammatory” type (n=27), and Group IV – the comparison group (n=20). Histological and histomorphological evaluation of excised scar tissue, clinical assessment of anamnestic indicators, and statistical data analysis were performed.
Results: Three main morphological variants of insufficient uterine scar were identified – "inflammatory," "vascular," and "connective tissue." The clinical and morphological parallels of insufficient uterine scar were assessed taking into account the histological variant. The patients with the "vascular" type of insufficient uterine scar had a history of irregular menstrual cycles (r=0.71; 95% CI 0.81;0.89 p<0.001). The main indication for delivery was the risk of uterine rupture along the scar (r=0.67; 95% CI 0.78;0.95 p<0.001). The patients with the "connective tissue" type of insufficient uterine scar underwent the first cesarean section due to abnormal labor (r=0.81; 95% CI 0.65;0.74 p<0.001). Uterine scar insufficiency – thinning of the uterine scar (< 2 mm) was detected by ultrasound. At the same time, the clinical picture showed no risk of uterine rupture along the scar (r=0.88; 95% CI 0.76;0.85 p<0.001). The "inflammatory type" of insufficient uterine scar correlated with recurrent miscarriage in history (r=0.65;
95% CI 0.58;0.83 p<0.001) and fetal distress in current pregnancy (r=0.63; 95% CI 0.61;0.81 p<0.001).
Conclusion: The obtained data indicate that there is a need for an in-depth study of the pathogenetic mechanisms of uterine scar formation and the development of a prediction model.

Authors' contributions: Nesterov V.F., Malgina G.B. – the concept and design of the study; Nesterov V.F., Dyakova M.M., Grishkina A.A. – data collection, analysis and interpretation of the results, the draft manuscript writing; Malgina G.B., Grishkina A.A. – the critical revision of the draft manuscript and formation of the final version. All authors approved the final version of the article before publication and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: The study was approved by the Ethics Committee of the Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia
Patient Consent for Publication: The patients have signed informed consent for publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Nesterov V.F., Malgina G.B., Dyakova M.M., Grishkina A.A. Clinical and
morphological variants of insufficient uterine scar after cesarean section.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (10): 62-72 (in Russian)
https://dx.doi.org/10.18565/aig.2025.197

pregnancy

cesarean section in history

insufficient uterine scar

morphological signs of insufficient uterine scar

Full text (in Russian)

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Received 18.07.2025

Accepted 30.09.2025

Vitaly F. Nesterov, PhD, Senior Researcher, Head of the Obstetric Department, Ural Scientific Research Institute for Maternal and Child Care, Ministry of Health of Russia, 620028, Russia, Yekaterinburg, Repin str., 1, +7(965)521-34-94, dr.nesterov2014@yandex.ru, https://orcid.org/0000-0002-5532-6587
Galina B. Malgina, Dr. Med. Sci., Professor, Scientific Secretary, Leading Researcher, Ural Scientific Research Institute for Maternal and Child Care, Ministry of Health
of Russia, 620028, Yekaterinburg, Repin str., 1, +7(343)371-08-78, galinamalgina@mail.ru, https://orcid.org/0000-0002-5500-6296
Maria M. Dyakova, PhD, Junior Researcher, Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia,
620028, Russia, Ekaterinburg, Repin str., 1, +7(343)37-189-11, +7(950)550-06-52, mariadakova40@mail.ru, https://orcid.org/0000-0001-7911-6783
Anastasia A. Grishkina, PhD, Pathologist, Head of the Department of Pediatric Pathology, Sverdlovsk Regional Bureau of Anatomical Pathology,
620028, Russia, Yekaterinburg, Volgogradskaya str., 185a, xumukyc.ru@mail.ru, https://orcid.org/0000-0001-7433-2217
Corresponding author: Vitaly F. Nesterov, dr.nesterov2014@yandex.ru

Clinical and morphological variants of insufficient uterine scar after cesarean section

Nesterov V.F., Malgina G.B., Dyakova M.M., Grishkina A.A.

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