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Background <p>The aim of this study was to evaluate the association between postpartum ultrasound assessment of the cesarean scar and obstetric outcomes in subsequent pregnancies.</p> Methods <p>We conducted a retrospective cohort study at a tertiary referral center between 2020 and 2022. Women who underwent postpartum transvaginal ultrasound assessment of the cesarean scar were compared with a historical reference group (2017–2019) with a previous cesarean delivery who did not undergo scar evaluation between pregnancies. Cesarean scar defects (CSD) were defined according to Delphi consensus criteria. Maternal and neonatal outcomes, including placenta accreta spectrum (PAS), uterine rupture, dehiscence and preterm birth, were compared between groups.</p> Results <p>During the study period, 481 women underwent postpartum ultrasound assessment of the cesarean scar. Of these, 141 women subsequently conceived and delivered at our institution and were included in the study group. These patients were compared with 393 women in a historical reference group. Among the 105 patients with complete ultrasound assessment according to the Delphi criteria, 30 (28.6%) were diagnosed with a cesarean scar defect, while 75 (71.4%) had no detectable defect. Patients in the study group were significantly older (<i>p</i> = 0.02) and had significantly (<i>p</i> &lt; 0.001) higher gravidity and parity than those in the reference group. The study group delivered at a significantly (<i>p</i> &lt; 0.001) earlier gestational age. Major obstetric complications, including placenta accreta spectrum (PAS), uterine rupture, or dehiscence, were significantly more common in the study group than in the reference group (8/131 (5.8%) vs. 7/393 (1.7%); <i>p</i> = 0.029). The rate of preterm birth was also significantly higher in the study group compared to the reference group (16/138 (11.5%) vs. 20/393 (4.8%); <i>p</i> = 0.009).</p> Conclusion <p>Implementation of a post-partum ultrasound follow-up program for patients delivered by cesarean section enables standardized identification of cesarean scar defects before a subsequent pregnancy. In this cohort, women with a cesarean scar defect had higher rates of obstetric complications in subsequent pregnancies than women without a detectable defect. Standardized postpartum ultrasound evaluation may support risk stratification in future pregnancies. However, the study was not designed to evaluate the impact of ultrasound findings on clinical management, and the findings should be interpreted as exploratory associations.</p>

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Evaluation of the role of post-partum ultrasound of cesarean delivery scar on subsequent pregnancy outcomes: a preliminary study

  • 期刊论文

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  • 发表日期：

    2026年7月15日

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  • Marina Pekar Zlotin,
  • Ron Maymon,
  • Nofar Ben-Basat,
  • Michal Well,
  • Yaakov Melcer,
  • Eric Jauniaux

摘要

Background

The aim of this study was to evaluate the association between postpartum ultrasound assessment of the cesarean scar and obstetric outcomes in subsequent pregnancies.

Methods

We conducted a retrospective cohort study at a tertiary referral center between 2020 and 2022. Women who underwent postpartum transvaginal ultrasound assessment of the cesarean scar were compared with a historical reference group (2017–2019) with a previous cesarean delivery who did not undergo scar evaluation between pregnancies. Cesarean scar defects (CSD) were defined according to Delphi consensus criteria. Maternal and neonatal outcomes, including placenta accreta spectrum (PAS), uterine rupture, dehiscence and preterm birth, were compared between groups.

Results

During the study period, 481 women underwent postpartum ultrasound assessment of the cesarean scar. Of these, 141 women subsequently conceived and delivered at our institution and were included in the study group. These patients were compared with 393 women in a historical reference group. Among the 105 patients with complete ultrasound assessment according to the Delphi criteria, 30 (28.6%) were diagnosed with a cesarean scar defect, while 75 (71.4%) had no detectable defect. Patients in the study group were significantly older (p = 0.02) and had significantly (p < 0.001) higher gravidity and parity than those in the reference group. The study group delivered at a significantly (p < 0.001) earlier gestational age. Major obstetric complications, including placenta accreta spectrum (PAS), uterine rupture, or dehiscence, were significantly more common in the study group than in the reference group (8/131 (5.8%) vs. 7/393 (1.7%); p = 0.029). The rate of preterm birth was also significantly higher in the study group compared to the reference group (16/138 (11.5%) vs. 20/393 (4.8%); p = 0.009).

Conclusion

Implementation of a post-partum ultrasound follow-up program for patients delivered by cesarean section enables standardized identification of cesarean scar defects before a subsequent pregnancy. In this cohort, women with a cesarean scar defect had higher rates of obstetric complications in subsequent pregnancies than women without a detectable defect. Standardized postpartum ultrasound evaluation may support risk stratification in future pregnancies. However, the study was not designed to evaluate the impact of ultrasound findings on clinical management, and the findings should be interpreted as exploratory associations.