Prospects for increasing the chances of successful vaginal delivery in women with a scar on the uterus after cesarean section

The review is devoted to one of the pressing problems of modern obstetrics — the delivery of women with a uterine scar after cesarean section. A scar on the uterus can cause various complications during pregnancy and childbirth. One of the main problems is scar failure. Pregnant women with a uterine scar, even after one cesarean section, should be considered at high risk for the development of complications. Visual diagnostic methods, such as ultrasound, magnetic resonance imaging, can only detect anatomical defects. Predicting the viability of a uterine scar is based, first of all, on a thorough analysis of data on a previous cesarean section. The choice of delivery method for pregnant women with a uterine scar is determined by its viability. It is not just the anatomical consistency of the uterine scar that is important, but also the functional one. The review presents criteria for diagnosing failure of the uterine scar according to ultrasound examination, data on the relationship between the initial thickness of the residual myometrium in the first trimester of pregnancy and the outcomes of pregnancy and childbirth. Considering that the functional viability of the uterine scar in subsequent pregnancies is largely determined by the course of reparative processes in the myometrium, especially the nature of angiogenesis, original studies are aimed at searching for diagnostic markers of the intensity of reparative angiogenesis. Generalization of existing knowledge about the possibilities of preclinical diagnosis of the consistency of the uterine scar will increase the number of vaginal births after cesarean section, reducing the number of abdominal births.