Effect of cesarean delivery on the endometrium

OBJECTIVE: To compare endometrial tissue samples from cesarean scar (CS) sites and from the posterior uterine wall to better understand the pathophysiology of implantation into a CS. METHODS: Endometrial samples were taken from both a CS site and the posterior wall in premenopausal women with CSs, and from the posterior wall in premenopausal women who had spontaneous vaginal deliveries (SVDs) only. RESULTS: In the secretory phase, there were significantly fewer leukocytes at CS sites than in the endometrium of women who had SVDs only (P<0.05). Significant differences in leukocytic infiltration and cell proliferation between the proliferative and secretory phases were only found in women who had SVDs only (P<0.05). CONCLUSION: Leukocyte recruitment to the endometrium during the secretory phase may be affected by the presence of a CS.