Scar Tenderness in Previous Cesarean Section: Correlation with Ultrasonographic Scar Thickness and Intraoperative Scar Integrity

Background: Cesarean section is one of the most commonly performed obstetric surgeries worldwide. Rising cesarean rates have led to an increasing number of pregnancies complicated by previous uterine scars. Scar-related complications such as scar thinning, dehiscence, and uterine rupture contribute significantly to maternal and fetal morbidity. The aim is to evaluate the relationship between clinical scar tenderness, ultrasonographic lower uterine segment (LUS) scar thickness, and intraoperative scar integrity in women undergoing cesarean section after a previous lower segment cesarean section (LSCS). Material and Methods: A prospective observational study was conducted on 50 pregnant women with previous one LSCS, singleton pregnancy, gestational age >36 weeks, and clinically detectable scar tenderness at Rohilkhand Medical College & Hospital, Bareilly. LUS thickness was measured by ultrasonography. Intraoperative findings (scar thinning, adhesions, dehiscence) and maternal–fetal outcomes were recorded. Associations were analysed using Fisher’s exact test. Results: Mean LUS thickness was 3.1 ± 0.6 mm. Thickness <2.5 mm was found in 11 (22%) women. Intraoperative thin scar was observed in 11 (22%) cases and scar dehiscence in 3 (6%) cases; all dehiscences occurred in the <2.5 mm group. No complete uterine rupture occurred. Women with LUS thickness <2.5 mm had significantly higher rates of thin scar (p < 0.001) and scar dehiscence (p = 0.008) compared with those with thickness ≥2.5 mm. Most women (90%) had an uneventful recovery. Conclusion: In women with previous LSCS and scar tenderness, ultrasonographic LUS thickness <2.5 mm is strongly associated with intraoperative thin scar and dehiscence. Scar tenderness alone does not reliably indicate impending rupture. Combined clinical and ultrasonographic assessment improves prediction of true scar integrity and supports safer obstetric decision-making.

Keywords: Cesarean Section, Cesarean Scar Tenderness, Ultrasonographic Scar Thickness, Lower Uterine Segment, Scar Integrity, Intraoperative Findings, Repeat Cesarean Delivery.