Effectiveness of vaginal metroplasty for treating cesarean scar defect: a comparative analysis of techniques
Malushko A.V., Fatkullina I.B., Shchedrina I.D., Alekseev S.M., Silakova V.R.
Objective: To evaluate the effectiveness of metroplasty via vaginal access in patients with uterine scar after cesarean section (CS).
Materials and methods: This comparative prospective study included 100 patients with a confirmed diagnosis of cesarean scar defect who were planning to become pregnant. The first group of patients (n=50) underwent metroplasty using vaginal access, 10 patients underwent laparotomy (group 2), and the third group (n=40) underwent metroplasty using traditional laparoscopic access. All patients in the study groups were evaluated based on the following criteria: complaints; condition of the uterine scar six months after surgery, as determined by ultrasound data; duration of surgery; amount of blood loss; characteristics of the pain syndrome experienced in the first six hours after surgery; and presence of complications. A comparative analysis of the results of the three surgical treatment methods was conducted.
Results: The following characteristics were identified in the study groups: after CS, the main complaints included menstrual cycle disorders, such as prolonged spotting after menstruation, heavy and frequent menstruation with a regular cycle (menorrhagia, polymenorrhea), painful menstruation, and secondary infertility. Following metroplasty in the study groups, clinical manifestations regressed in all patients after six months. The mean minimum thickness of the myometrium in the scar area increased significantly: in group 1, it ranged from 3.8 to 5.35 mm with a mean value of 5.3 (0.8) mm; in group 2, it ranged from 4.5 to 5.2 mm with a mean value of 4.9 (0.3) mm; and in group 3, it ranged from 3.8 to 5.3 mm with a mean value of 4.7 (0.5) mm. The “scar thickness, mm” indicator dynamics were significantly different before and after metroplasty in all the study groups (p<0.0001). The use of the vaginal method of uterine scar correction showed comparable results, with the following features noted: the duration of the operation in group 1 ranged from 20 to 55 min, with a median time of 35 (30; 40) min; in group 2, the duration of the operation ranged from 75 to 120 min, with a median time of 95 (90; 120) min; and in group 3, the duration of the operation ranged from 70 to 135 min, with a median time of 95 (90; 110) min. This is associated with a more technically simplified surgical correction technique that does not require a laparoscopic stand. Group 1 differed significantly from groups 2 and 3 (p1,2=0.0003 and p1,3<0.0001, respectively). The following features were identified when assessing the severity of pain syndrome using VAS: in group 1, the VAS score ranged from 1 to 5 points, with a median of 2 (2; 3); in group 2, it ranged from 6 to 7 points, with a median of 6 (6; 7); and in group 3, it ranged from 4 to 6 points, with a median of 5 (4; 5). Group 1 significantly differed from groups 2 and 3 (p1,2= 0.00002 and p1,3= 0.00030, respectively), whereas groups 2 and 3 did not differ significantly in terms of VAS scores (p2,3= 0.79). Histological examination of the uterine scar in the study material revealed moderate to severe expression of markers of chronic endometritis (CD 138, CD 56, and CD 20), indicating a chronic inflammatory process, concurrent infertility, miscarriage, and failed in vitro fertilization attempts. In several cases, endometrioid lesions were observed in the study material.
Conclusion: The study demonstrated that vaginal access metroplasty is highly effective and has certain advantages over traditional laparoscopic techniques. Therefore, it can be considered the preferred surgical treatment option in areas with limited resources and appropriately qualified specialists.
Authors' contributions: Malushko A.V., Fatkullina I.B., Alekseev S.M. – conception and design of the study; Shchedrina I.D., Malushko A.V., Silakova V.R. – data collection and analysis; Shchedrina I.D., Malushko A.V. – statistical analysis, drafting of the manuscript; Fatkullina I.B., Malushko A.V., Alekseev S.M. – editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Leningrad Regional Clinical Hospital.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Malushko A.V., Fatkullina I.B., Shchedrina I.D., Alekseev S.M., Silakova V.R. Effectiveness of
vaginal metroplasty for treating cesarean scar defect: a comparative analysis of techniques.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (11): 86-94 (in Russian)
https://dx.doi.org/10.18565/aig.2025.206
Keywords
cesarean section
cesarean scar defect
vaginal metroplasty
reproductive health
laparoscopy
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Received 30.07.2025
Accepted 05.11.2025
About the Authors
Anton V. Malushko, obstetrician-gynecologist, Head of Gynecological Department, Leningrad Regional Clinical Hospital, 194291, Russia, St. Petersburg, Lunacharsky Ave.,45, bldg. 2, litera A, +7(812)670-18-88, a-malushko@mail.ru, https://orcid.org/0000-0002-4460-9075
Irina B. Fatkullina, Dr. Med. Sci., Deputy Chief Physician for Obstetrics and Gynecology, Republican Clinical Perinatal Center, Ministry of Health of the Republic of Bashkortostan; Professor at the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia, 450008, Russia, Ufa,
Lenin str., 3, https://orcid.org/0000-0001-5723-2062
Irina D. Shchedrina, PhD, obstetrician-gynecologist at the Gynecological Department, Leningrad Regional Clinical Hospital, 194291, Russia, St. Petersburg, Lunacharsky Ave., 45, bldg. 2, litera A, +7(982)651-42-98, forgottenz@mail.ru, https://orcid.org/0000-0003-0062-1256
Sergey M. Alekseev, PhD, Chief Oncologist and Chief Hematologist of the Leningrad Region, Chief Physician, Leningrad Regional Clinical Hospital, 194291, Russia,
St. Petersburg, Lunacharsky Ave., 45, bldg. 2, litera A, bmt312@gmail.com
Valeriia R. Silakova, student at the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
(Sechenov University), 119021, Russia, Moscow, Rossolimo str., 11, bldg. 2, +7(499)245-27-79, lerasilakova1108@gmail.com, https://orcid.org/0009-0009-0390-7525
Corresponding author: Irina D. Shchedrina, forgottenz@mail.ru
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