Symptomatic niches in the uterine scar after cesarean section: analysis of the causes of development and clinical manifestations

Objective. Identification of the most significant reasons for the development of symptomatic niches. Material and methods. In the course of the study, two groups were formed: the main and the control. The main group consisted of 2 subgroups: Ia subgroup — 58 patients with clinical manifestations of insolvent scar on the uterus after CC and the thickness of retained myometry 2 mm Ib — 48 patients with insolvent scar on the uterus and the thickness of retained myometry 2 mm, but without symptoms. In order to identify the causes of the development of an insolvent scar on the uterus, a control group was created — patients (n=32) with a scar on the uterus after a caesarean section. Results. The causes of the development of large symptomatic niches (an incompetent scar on the uterus) are: the course of pregnancy complicated by exacerbation of bronchopulmonary diseases (HR=2.53; 95% CI: 1.096—5.867) and genitourinary systems (HR=4.07; 95% CI: 1.024—16.214); anhydrous interval ≥12 hours (HR=10.2; 95% CI: 1.462—72.066); emergency CS (HR=2.19, 95% CI: 1.344—3.587); incision on the uterus repaired with a single-row suture (HR=2.6; 95% CI: 1.016—6.871); intrauterine interventions in the early postoperative period (HR=7.2; 95% CI: 1.020—51.486); adenomyosis (p<0.05), duration of labor for ≥6 hours (HR=2.7; 95% CI:1.206—6.395). Conclusion. Symptomatic scar niches on the uterus after a large cesarean section are a multifactorial disease. Symptoms of an untenable scar on the uterus can begin to bother patients as early as 6 months to 5 years after CS, averaging 2.3±0.4 years and have various clinical manifestations.