Standardized examination of postoperative uterine scar

Gus A.I., Yarygina T.A., Mikheeva A.A., Voеvodina V.I., Shmakov R.G.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia 2) A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
This publication reviews the international guidelines approved in 2019 on the standards for ultrasound, examination of the postoperative uterine scar, by taking into account the Delphi system for harmonizing the opinions of leading world experts. The importance of unifying the methodology of an investigation and the terminology for describing the ultrasound image is due to the global trend of an increase in the rate of cesarean section and related postoperative and long¬term complications. Numerous studies of myometrial scar defect at cesarean section have confirmed its role in the development of abnormal uterine bleeding, dysmenorrhea, and complications in subsequent pregnancies, including scar ectopic pregnancy and abnormal placental invasion. In turn, organ-sparing surgeries for placenta increta lead to an increase in the number of patients with multiple areas of myometrial cicatricial changes, the long-term consequences of which have not yet been studied.
This publication describes in detail the methodological aspects of both the standard ultrasound examination and echo contrast technology and sets out the definitions and concepts of echographic criteria to define the niche, the thickness of the residual and adjacent myometrium. It presents the sampling protocol for transvaginal ultrasound examination of a postoperative scar area, which can be used for all groups of patients who have undergone cesarean section, including cases of organ-sparing surgeries for placenta increta.
Conclusion: The daily clinical introduction of a standardized approach to assessing the postoperative uterine scar and describing pathological changes in its area will be able to reach interdisciplinary and clinical consensus, to expand the possibilities of monitoring ongoing studies, to obtain evidence-based information on the correlation of ultrasound and clinical patterns, thereby contributing to improving the quality of medical care.


cesarean section
uterine scar
myometrial defect
ultrasound examination


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Received 15.11.2021

Accepted 01.12.2021

About the Authors

Alexandr I. Gus, Dr. Med. Sci., Professor, Chief Researcher of Ultrasound and Functional Diagnostics Department, Radiology Division, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,,, 117997, Russia, Moscow, Oparina str., 4.
Tamara A. Yarygina, MD, PhD, Specialist of Ultrasound Diagnostics, Perinatal Cardiology Center, Researcher, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, +7(495)414-78-75,,, 121552, Russia, Moscow, Roublyevskoe Shosse, 135.
Alexandra A. Mikheeva, PhD Student, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495) 438-30-47,,, 117997, Russia, Moscow, Oparina street, 4.
Vlada I. Voevodina, PhD Student, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495)438-30-47,,, 117997, Russia, Moscow, Oparina str., 4.
Roman G. Shmakov, Dr. Med. Sci., Professor, Director of Institute of Obstetrics, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia; Chief Freelance Specialist in Obstetrics of the Ministry of Health of the Russian Federation, +7(495)438-72-00,,, 117997, Russia, Moscow, Oparina str., 4.

Authors’ contributions: Yarygina T.A., Shmakov R.G., Gus A.I. - concept and design of the investigation; Mikheeva A.A., Yarygina T.A., Voevodina V.I. - writing the text; Mikheeva A.A., Yarygina T.A., Voеvodina V.I. - material collection and processing; Shmakov R.G., Gus A.I. - editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has been conducted without additional funding.
For citation: Gus A.I., Yarygina T.A., Mishieva N.G., Voevodina V.I., Shmakov R. G. Standardized examination of postoperative uterine scar.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 1:42-47(in Russian)

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