Uterine scar after cesarean section: from uterine closure technique to reducing the risk of obstetric complications

DOI

https://dx.doi.org/10.18565/aig.2026.28

Ignateva A.A., Luzina E.A., Kan N.E., Tyutyunnik V.L.
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

The worldwide rise in the rate of cesarean sections is leading to an increasing number of women with uterine scars and the associated complications. These include serious conditions such as cesarean scar defect (uterine niche), the risk of uterine rupture along the scar in subsequent pregnancies, and placenta accreta spectrum disorders. The most modifiable component in the prevention of these complications remains the choice of optimal surgical technique for cesarean section and reconstructive procedures on the uterus.
The review analyzes the epidemiology of cesarean delivery, the clinical significance of cesarean scar defects, and the main risk factors for their development. It summarizes the results of randomized trials and meta analyses comparing different uterine closure techniques and their impact on residual myometrial thickness, the prevalence of uterine niche, and the risk of uterine rupture. Special attention is given to the indications and outcomes of intraoperative metroplasty performed during repeat cesarean section.
The most physiological and safest uterine closure method appears to be a double layer continuous unlocked suture without inclusion of the endometrium, which provides superior scar characteristics without increasing the rate of complications. In case of repeat cesarean section and signs of scar dehiscence or marked thinning, intraoperative metroplasty is advisable, as it may reduce the risk of subsequent defective scar formation, abnormal placentation, and uterine rupture.
Conclusion. Further research is required to standardize the indications for metroplasty and to compare outcomes according to the specific surgical technique used.

Authors’ contributions. Ignateva A.A., Luzina E.A., Kan N.E, Tyutyunnik V.L. – developing the concept and design of the study, obtaining data for analysis, collecting publications, processing and analysis of the material on the topic, writing the text of the manuscript, editing the article.
Conflicts of interest. The authors declare no potential conflicts of interest related to the publication of this article.
Funding. The study was conducted without sponsorship.
For citation: Ignateva A.A., Luzina E.A., Kan N.E., Tyutyunnik V.L. Uterine scar after cesarean section:
from uterine closure technique to reducing the risk of obstetric complications.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (5): 22-28 (in Russian)
https://dx.doi.org/10.18565/aig.2026.28

cesarean section

uterine scar

cesarean scar defect

uterine rupture

placenta accreta spectrum

metroplasty

uterine closure

cesarean section surgical technique

repeat cesarean section

Full text (in Russian)

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Received 02.02.2026

Accepted 19.03.2026

Alla A. Ignateva, PhD, Head of the 2nd Physiological Obstetrics Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, a_ignateva@oparina4.ru, https://orcid.org/0009-0009-4194-3199
Evgenia A. Luzina, PhD student, obstetrician-gynecologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(987)696-82-34, zhenyaluz@gmail.com, https://orcid.org/0000-0003-0918-2720
Natalia E. Kan, Professor, Dr. Med. Sci., Honored Scientist of the Russian Federation, Deputy Director General for Research – Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparina str., 4, kan-med@mail.ru, Researcher ID: B-2370-2015, SPIN-code: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600,
https://orcid.org/0000-0001-5087-5946
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at the Center for Scientific and Clinical Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, tioutiounnik@mail.ru,
Researcher ID: B-2364-2015, SPIN-code: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Corresponding author: Evgenia A. Luzina, zhenyaluz@gmail.com

Uterine scar after cesarean section: from uterine closure technique to reducing the risk of obstetric complications

Ignateva A.A., Luzina E.A., Kan N.E., Tyutyunnik V.L.

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