Morphological Changes in the Uterine Wall After Cesarean Section and Their Associations with Infertility and Pregnancy Complications: A Literature Review

Abstract

Objective. To evaluate the morphological changes in the uterine wall after cesarean section and their association with infertility and pregnancy complications, including the formation of a cesarean scar niche (isthmocele), inflammatory processes, cesarean scar pregnancy (CSP), and abnormal placental attachment (PAS). Methods. A literature review was conducted to assess structural changes in the uterine wall following cesarean section and their impact on menstrual disorders, fertility, and pregnancy complications. Using relevant keywords, a search was performed in the PubMed, Medline, and Cochrane Library databases, and 34 articles meeting the inclusion criteria for the literature analysis were selected and analyzed. Results. The cesarean scar niche is associated with adenomyosis, chronic inflammation, and altered endometrial structure, increasing the risk of infertility. Thinning of the uterine wall in the scar area is linked to a higher risk of uterine rupture during labor. Additionally, the presence of a cesarean scar increases the likelihood of CSP and PAS, which are associated with severe pregnancy and childbirth complications. Conclusions. The cesarean section scar may have long-term negative effects on female fertility and subsequent pregnancies. Keywords: cesarean section scar, cesarean scar niche, cesarean scar pregnancy, infertility, pregnancy complications.