Cesarean section is one of the leading methods of delivery, with a global trend toward increasing frequency. According to statistical data, 15.2% to 42% of all deliveries are performed via cesarean section [1]. One of the significant complications following cesarean section is uterine scar insufficiency, which is particularly important when planning subsequent pregnancies. The risk of scar rupture, accompanied by life-threatening hemorrhage, ranges from 0.62% to 9% [2].

Cesarean section, uterine scar insufficiency, scar defect, niche, uterine rupture, myometrial thinning, postoperative complications, placenta accreta spectrum, adhesion process, ultrasound diagnostics, magnetic resonance imaging (MRI), reconstructive uterine surgery, obstetric outcomes, reproductive health, interpregnancy monitoring.

World Health Organization. (2015). Practice Guide on Cesarean Section. Geneva: WHO.

R.M. Silver. (2012). Delivery after previous cesarean: long-term maternal outcomes. Semin Perinatol, 36(5): 411-417.

A. Tower, F. Regan. (2017). Scar pregnancy after cesarean section. Obstet Gynecol, 109(6): 1373-1380.

S.I. Stegwee, L. Klinkert, E. Hink, M. Lambregts, R.A. de Leeuw, P.M. van de Ven, et al. (2018). Systematic review and meta-analysis of surgical techniques for Cesarean scar defect repair. Ultrasound Obstet Gynecol, 51(2): 176-185.

A.P. Betran, J. Ye, A.B. Moller, J.P. Souza, J. Zhang. (2021). Trends and projections of cesarean section rates: global and regional estimates. BMJ Global Health, 6(6): e005671.

E.N. Rovenskaya, N.V. Letova, L.S. Solovyova, L.A. Chebotareva. (2020). Cesarean scar insufficiency: modern aspects of diagnosis and treatment. Obstetrics and Gynecology, 3: 43-48.

M. Tanimura, et al. (2017). A new scoring system for predicting cesarean scar defect in pregnant uterus. J Obstet Gynaecol Res, 43(10): 1523-1529.

O.V. Osser, L. Jokubkiene, L. Valentin. (2010). High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol, 36(1): 72-77.

A.Y. Razumovsky, O.G. Samokhvalova, Yu.I. Belousova. (2019). Cesarean section: optimization of surgical techniques. Russian Journal of Obstetrician-Gynecologist, 19(3): 41-46.

O. Vikhareva, L. Valentin. (2011). Clinical importance of cesarean hysterotomy scar appearance at routine transvaginal sonographic examination in nonpregnant women. Obstet Gynecol, 117(3): 525-532.

A.Y. Sobolev, L.I. Melnik. (2020). Obstetric complications after cesarean section. Russian Journal of Obstetrician-Gynecologist, 20(5): 60-66.

O. Naji, A. Daemen, A. Smith, et al. (2012). High prevalence of uterine niches in women with cesarean section scar: a systematic review and meta-analysis. Hum Reprod, 27(7): 2021-2032.

A.F. Chugunova, I.A. Karpova, S.K. Alimova. (2018). Features of ultrasound diagnostics of the uterine scar after cesarean section. Obstetrics and Gynecology, 4: 45-49.

I.E. Timor-Tritsch, A. Monteagudo. (2019). Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol, 221(6): 557-569.

N.N. Yudina, O.I. Efremova. (2020). Cesarean section: impact on women’s reproductive health. Obstetrics and Gynecology, 5: 7-12.

S. Ferrero, E. Arena, A. Morando, V. Remorgida, U. Leone Roberti Maggiore. (2019). Reproductive outcomes after cesarean scar pregnancy: a systematic review and meta-analysis. J Ultrasound Med, 38(6): 1561-1569.

A.V. Chirkova, E.M. Zakharova, E.A. Ignatova. (2021). Modern approaches to the diagnosis and treatment of cesarean scar insufficiency. Issues of Gynecology, Obstetrics and Perinatology, 20(3): 78-85.

A. Kaelin Agten, G. Cali, A. Monteagudo, J. Oviedo, J. Ramos, I.E. Timor-Tritsch. (2017). The clinical outcome of cesarean scar pregnancies implanted “on the scar” vs. “in the niche”. Am J Obstet Gynecol, 216(5): 510.e1-510.e6.

L.V. Adamyan, R.R. Damirov, E.V. Tskhai, E.N. Malyutina. (2019). The impact of cesarean section on maternal mortality. Obstetrics and Gynecology, 5: 13-17.

D. Jurkovic, K. Hillaby, B. Woelfer, A. Lawrence, R. Salim, C.J. Elson. (2003). First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol, 21(3): 220-227.

N. Gonzalez, T. Tulandi. (2017). Cesarean Scar Pregnancy: A Systematic Review. J Minim Invasive Gynecol, 24(5): 731-738.

N.M. Zelenskaya, Yu.A. Arbatskaya, N.V. Sivova, I.V. Kovalenko, E.N. Pechenina. (2020). Features of diagnosis and management of patients with scar changes in the uterus. Issues of Gynecology, Obstetrics and Perinatology, 19(3): 72-78.