Ultrasound assessment of uterine scar competence during labor

Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O., Todorov S.S., Barinova V.V.

1) Rostov State Medical University, Ministry of Health of the Russian Federation, Rostov-on-Don, Russia; 2) Professor Bushtyreva Clinic LLC, Rostov-on-Don, Russia
Background: Fear of vaginal delivery is most commonly associated with uterine rupture in women with post-cesarean uterine scar. The fact that the morphological competence of the scar and its ability to dehisce at the onset of labor cannot be prognostically evaluated necessitates the exchange of experience in managing vaginal delivery with uterine scar.
Materials and methods: A prospective study of 41 pregnant women with a uterine scar after a single cesarean section was conducted. All the women were scheduled for vaginal delivery. Uterine scar competence was assessed clinically and ultrasonographically at the onset of labor.
Results: Twenty-six women delivered vaginally; 15 were re-operated. The indications for repeat cesarean section were labor abnormalities (n=7), clinically narrow pelvis (n=4), and threat of uterine scar incompetence (n=4). Intraoperatively, the uterine scar was competent in 11 patients; there was scar incompetence, incomplete uterine rupture, and uterine scar dehiscence in 4, 2, and 2 patients, respectively.
Conclusion: The causes of unsuccessful attempts at vaginal delivery after caesarean section are not always associated with scar incompetence. The scars most commonly turn out to be intraoperatively competent. It is advisable to ultrasonographically assess scar competence at the onset of labor in women planning vaginal delivery.


attempt at vaginal delivery in the presence of uterine scar
cesarean section
incomplete uterine rupture
uterine scar dehiscence


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Received 02.03.2022

Accepted 01.06.2022

About the Authors

Natalya B. Kuznetsova, Dr. Med. Sci., Professor at the Center for Simulation Training, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia,
Rostov-on-Don, Nakichevanskiy str., 29; Chief Physician, Clinic of Professor Bushtyreva, 344011, Russia, Rostov-on-Don, Sobornyi str., 58/7, +7(928)770-97-62,
lauranb@inbox.ru, https://orcid.org/0000-0002-0342-8745
Gulmira M. Ilуasova, post-graduate student, Rostov State Medical University, Ministry of Health of Russia, +7(989)613-04-03, gulmirka666@mail.ru,
344022, Russia, Rostov-on-Don, Nakhichevansky str., 29.
Irina O. Bushtyreva, Dr. Med. Sci., Professor, Director of the Clinic of Professor Bushtyreva, +7(928)296-15-97, kio4@mail.ru,
344011, Russia, Rostov-on-Don, Sobornyi str., 58/7.
Sergey S. Todorov, Dr. Med. Sci., Associate Professor, Head of the Department Pathological Anatomy, Head of the Morphological Department of the Clinic, Rostov State Medical University, Ministry of Health of Russia, +7(918)508-37-89, sertodorov@gmail.com, 344022, Russia, Rostov-on-Don, Nakhichevansky str., 29.
Viktoriya V.Barinova, PhD, Assistant Professor at the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevanskiy str., 29; Head of the Obstetric Department, Clinic of Professor Bushtyreva,
344011, Russia, Rostov-on-Don, Soborniy str., 58/7, +7(928)909-55-68, victoria-barinova@yandex.ru, https://orcid.org/0000-0002-8584-7096
Corresponding authors: Natalya B. Kuznetsova, lauranb@inbox.ru; Gulmira M. Ilyasova, gulmirka666@mail.ru

Authors' contributions: Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O. – concept and design of the investigation; Kuznetsova N.B., Ilyasova G.M. – material collection and processing; Kuznetsova N.B., Ilyasova G.M., Todorov S.S. – writing the text; Kuznetsova N.B., Todorov S.S., Barinova V.V. – editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Rostov State Medical University, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
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: Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O., Todorov S.S., Barinova V.V. Ultrasound assessment of uterine scar competence during labor.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 6: 114-121 (in Russian)

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