Cesarean Section Complications and Uterine Scar Healing

Caesarean section remains one of the most frequently performed surgical procedures worldwide, yet it carries specific immediate and long-term maternal risks. Early complications include haemorrhage, infection and injury to adjacent organs, while later sequelae may manifest as abnormal uterine bleeding, chronic pelvic pain, subfertility and abnormal placentation in subsequent pregnancies. Central to these outcomes is the process of uterine scar healing, which follows classical phases of inflammation, proliferation and remodelling. Optimal myometrial regeneration depends on adequate blood supply, precise surgical closure and minimisation of infection. However, incomplete healing can lead to defects in the myometrial layer, forming niches or diverticula that trap menstrual blood, foster chronic inflammation and alter uterine biomechanics. Such defects have been linked to scar dehiscence, increasing the risk of uterine rupture and placenta accreta spectrum disorders. Management strategies range from expectant monitoring with imaging to surgical niche repair by hysteroscopic, laparoscopic or vaginal approaches. A better understanding of the biological and mechanical factors influencing scar integrity is essential to reduce complications and improve reproductive outcomes.

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Cesarean Section Complications and Uterine Scar Healing publication trend

The graph below shows the total number of articles in cesarean section complications and uterine scar healing across all publications each year (not limited to Nature Index journals).

Technical terms

Cesarean scar defect (CSD): a discontinuity or indentation of the myometrial layer at the site of a previous caesarean section.

Isthmocele: a triangular niche in the anterior uterine wall at the caesarean scar that communicates with the endometrial cavity.

Residual myometrial thickness (RMT): the remaining thickness of uterine muscle overlying a scar defect, often measured by ultrasound.

Scar dehiscence: partial separation of the healed uterine scar, which may precede complete uterine rupture in subsequent pregnancies.

References

1. Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. PLOS Medicine (2024).
2. Fungal–bacteria interactions provide shelter for bacteria in Caesarean section scar diverticulum. eLife (2024).
3. Isthmocele, not cesarean section per se, reduces in vitro fertilization success: a systematic review and meta-analysis of over 10,000 embryo transfer cycles. Fertility and Sterility (2023).
4. Isthmocele: an overview of diagnosis and treatment. Revista da Associação Médica Brasileira (2019).