Uterine scar after caesarean section: principles of healing and evaluation criteria

Caesarean delivery results in the formation of a uterine scar. Inadequate scar healing and subsequent formation of an incompetent uterine scar tissue are common complications that may lead to the abnormal uterine bleeding, painful menstrual periods, and secondary infertility. In pregnant women, an incompetent scar may cause life-threatening complications, such as uterine rupture at any gestational age or placenta increta at the scar level. Given the potential dangers of uterine scars, numerous recent studies have focused on identifying risk factors and understanding the pathophysiology of incompetent scar formation, as well as developing diagnostic methods. Early diagnosis is essential in maintaining women’s health and well-being and preventing complications in subsequent pregnancies. Unfortunately, there is currently neither exact understanding of the pathophysiological mechanism of uterine scar formation, nor unambiguous guidelines on some aspects of its diagnosis after caesarean section.