RISK FACTORS AND PREDICTION OF UTERINE SCAR INSUFFICIENCY AFTER CAESAREAN SECTION
Keywords:
uterine scar insufficiency, cesarean section, risk factors, prediction, prognostic coefficient, emergency cesarean section, postpartum complications, fetopelvic disproportionAbstract
Objective: To identify significant risk factors and develop a method for predicting uterine scar insufficiency after cesarean section. Materials and Methods: A retrospective comparative analysis was performed in women with uterine scar insufficiency after cesarean section who were admitted with postpartum purulent-septic complications, as well as in women with an uncomplicated postpartum period and adequate uterine scar repair. Clinical history, indications and timing of cesarean section, parity, number of previous cesarean sections, postpartum complications, somatic and gynecological comorbidities were analyzed. Statistical assessment included prognostic coefficients (PC), odds ratios (OR), relative risks (RR), and Fisher's criterion (F). Results: The highest risk of uterine scar insufficiency was associated with emergency cesarean section (PC=+17.5; F=5.8; OR=9.6; RR=8.1) and cesarean section performed during labor (PC=+13.7; F=4.7; OR=7.0; RR=8.9). The most significant indications were poor labor progress (F=4.3; OR=7.2; RR=8.2) and fetopelvic disproportion (F=3.8; OR=6.4; RR=4.5). Two or more previous cesarean sections were also associated with increased risk (PC=+5.1; F=3.4; OR=7.4; RR=6.6). Severe preeclampsia (F=2.9; OR=7.9; RR=7.5), postpartum purulent-inflammatory complications (F=5.6; OR=7.5; RR=7.2), and their combination with somatic pathology (F=5.5; OR=6.4; RR=4.5) were significant predictors. Conclusion: Emergency cesarean section, operative delivery during labor, poor labor progress, fetopelvic disproportion, repeated cesarean sections, severe preeclampsia, and postpartum infectious-inflammatory complications are major risk factors for uterine scar insufficiency. A prognostic coefficient threshold of ≥+13 points allows identification of patients with a 95% probability of unfavorable prognosis. The proposed risk assessment may facilitate early identification of high-risk women and timely preventive and diagnostic measures.
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