Endometriosis of the uterine scar after cesarean section is like an invisible disease. Difficulties in diagnosis

A. A. Grigoryants, V. V. Avrutskaya, И. И. Крукиер, М. А. Левкович, Н. В. Ермолова
In: Medical Herald of the South of Russia · 2025 · vol. 16(3) , pp. 5–15 · doi:10.21886/2219-8075-2025-16-3-5-15 · W4414512555
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Abstract

Objective: to analyze cases of surgical correction of uterine scar failure aſter cesarean section, to determine the frequency of detection of endometriosis of the uterine scar according to histological findings and to identify the effectiveness of diagnostic methods. Materials and methods: a retrospective analysis of the medical records of 52 patients from January 2022 to December 2024, who underwent surgical correction of a uterine scar aſter cesarean section with its failure, was carried out. Results: our correlation analysis revealed that in most cases, uterine scar endometriosis was asymptomatic, however, in rare cases, a connection was observed between patients’ complaints of abnormal uterine bleeding (AUB) and uterine scar endometriosis. The absence of complaints in endometriosis confirms its asymptomatic course. Due to the latent and difficult to diagnose course of the disease, as part of pre-pregnancy preparation in women with a uterine scar, it is necessary to use a comprehensive diagnostic approach, combining non-invasive methods with hysteroscopy, to increase the frequency of detection of scar endometriosis. This will allow timely surgical treatment and prevent disease progression. Conclusion : ultrasound examination as a method for diagnosing endometriosis of the uterine scar aſter ACS showed low sensitivity in detecting this pathology, despite the high resolution of modern ultrasound devices. Magnetic resonance imaging and diagnostic hysteroscopy are recommended as diagnostic methods. In turn, a combination of methods for diagnosing a scar on the uterus aſter ACS as part of pregravid preparation will make it possible to increase the frequency of detecting endometriosis of the uterine scar and will allow timely surgical treatment of the identified pathology.

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endometriosis

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