OVERVIEW

What is a Scarred Uterus?

A scarred uterus, commonly referred to as a scarred womb, is the result of scarring in the uterine area caused by various factors such as cesarean sections, uterine fibroid surgeries, or other traumatic injuries.
The incidence of scarred uterus is relatively high, particularly among women with a tendency for scarring or older mothers. The endometrium and muscle layer at the scar site become thinner. To avoid complications like placenta previa, placenta accreta, or scar pregnancy, it is generally recommended to wait two to three years after the scar has healed before considering another pregnancy.

SYMPTOMS

What are the clinical manifestations of a scarred uterus?

• The maternal endometrium becomes thinner, and unevenness can be felt at the scar site.

• Due to frequent local defects in the endometrium at the uterine scar, when the fertilized egg implants here during a subsequent pregnancy, it cannot undergo sufficient proliferation and differentiation. Alternatively, if implantation initially occurs in normal endometrium, trophoblast cells may expand into areas of poorly proliferated and differentiated endometrium during development. Therefore, when the fertilized egg implants at the site of endometrial defects in the scar, placental villus implantation is highly likely to occur.

• Implantation of the fertilized egg in the lower uterine segment may develop into placenta previa.

How does a scarred uterus affect mothers who want to conceive again?

Because the endometrium or myometrium at the scar site is relatively thin, it poses various risks or complications for mothers attempting another pregnancy. These include a significantly increased risk of uterine rupture, placenta accreta, postpartum hemorrhage, placental abruption, and intrauterine fetal death, which can endanger both mother and child. Therefore, women with a scarred uterus who wish to conceive again must take extra precautions and undergo regular check-ups.

CAUSES

What are the causes of a scarred uterus?

The causes of a scarred uterus are varied, including gynecological surgeries such as cesarean sections, myomectomy, uterine perforation or rupture repair, uterine reconstruction, as well as uterine tumors, induced abortions, and other procedures. Among these, myomectomy and cesarean sections are the most common.

Is a scarred uterus hereditary?

A scarred uterus itself is not hereditary, but a tendency for keloid formation (scarring) may have some genetic association.

Compared to a normal, uninjured uterus, a scarred uterus carries a higher risk of uterine rupture or damage during childbirth. Therefore, cesarean delivery is often recommended for women with a scarred uterus. However, repeated cesarean sections can further damage the uterus and negatively impact the patient's future quality of life. As a result, vaginal delivery is also actively encouraged when feasible.

DIAGNOSIS

How is a scarred uterus diagnosed?

• There is usually a history of uterine trauma, such as cesarean section or gynecological surgeries like myomectomy.

• Thinning of the endometrium or myometrium, with visible scarring on the uterus.

• Imaging tests such as ultrasound, MRI, or Doppler ultrasound can detect thinning of the myometrium or endometrium and identify scarred areas. This is particularly important for detecting complications when a scarred uterus is involved in another pregnancy.

TREATMENT

How to treat a scarred uterus?

Generally, transabdominal scar repair surgery is used to treat a scarred uterus.

During and after the surgery, infection should be prevented, antibiotics should be used appropriately, and scar repair should be promoted.

What is the optimal time for pregnancy after a scarred uterus?

Two to three years after a cesarean section is when the scar healing of the uterus reaches its best condition, so pregnancy two to three years after a cesarean section is more suitable. After uterine fibroid surgery, contraception should be used for at least six months.

When should pregnancy be terminated for women with a scarred uterus?

• If the incision of a scarred uterus after cesarean section heals well, the optimal time for termination is at 39 weeks of pregnancy. If the incision is damaged or infected, the suitable time is 36–37 weeks.

• For a scarred uterus after uterine fibroid surgery, the decision should be based on the severity of the disease and the surgical conditions.

• If there are severe complications such as bleeding or fetal distress, pregnancy should be terminated immediately.

What are the safer methods for terminating pregnancy in a scarred uterus?

Termination of pregnancy in a scarred uterus can be performed using mifepristone and misoprostol combined with uterine curettage. This method has good abortion effects, high safety and reliability, and significant clinical value, so women with a scarred uterus can feel relatively reassured.

How should women with a scarred uterus choose the delivery method for a subsequent pregnancy?

To reduce pain, most women prefer cesarean delivery, which is safer and less painful for the mother, but it carries more complications. If necessary, women with a scarred uterus can opt for vaginal delivery.

What are the effects of choosing cesarean delivery for a scarred uterus on the mother and baby?

Cesarean delivery for a scarred uterus during subsequent childbirth carries higher surgical complications and risks, longer surgery and hospitalization times, an increased likelihood of neonatal asphyxia, greater postpartum blood loss, and higher rates of complications such as puerperal infection, poor wound healing, and pelvic-abdominal adhesions. Therefore, pregnant women with a scarred uterus should avoid choosing cesarean delivery without medical indications.

What are the effects of choosing vaginal delivery for a scarred uterus on the mother and baby?

Vaginal delivery for women with a scarred uterus involves greater blood loss, a longer labor process, more maternal pain compared to cesarean delivery, and a higher risk of uterine rupture. Vaginal delivery can be considered if contraindications are excluded and strict indications are met.

What are the indications for choosing vaginal delivery for a scarred uterus?

• The previous cesarean incision was T-shaped.

• At least two years have passed since the previous cesarean section.

• No history of uterine rupture.

• The hospital has the necessary conditions to handle emergencies.

• The pregnant woman is no older than 35, and the fetal weight is within the normal range (not exceeding 3.5 kg).

• The pregnant woman is willing to undergo vaginal delivery after understanding its advantages and risks and can accept the associated risks.

DIET & LIFESTYLE

What issues should women with a scarred uterus pay attention to?

• Women with a scarred uterus should use contraception until the scar heals optimally and undergo regular uterine examinations to assess the healing progress of the scar;

• If a missed period occurs, seek immediate medical examination to rule out pregnancy at the scar site and prevent complications early;

• During prenatal checkups, confirm the relationship between the placenta and the scar site, and monitor changes in the thickness of the uterine muscle layer;

• During pregnancy, especially in the later stages, protect the uterus carefully—avoid abdominal pressure, refrain from crowded places, manage emotions to prevent anger, and limit sexual activity.

PREVENTION

How should women with scarred uterus care for themselves and prevent complications in daily life?

• Practice active contraception for at least two years.

• Maintain a balanced diet and avoid excessive intake of high-fat foods to prevent uterine fibroids.

• Monitor menstrual flow and vaginal discharge regularly, noting any changes in volume, color, or abnormalities, and seek medical attention if irregularities occur.

• Engage in moderate sexual activity, avoid promiscuity, and protect the uterus. Preventing scarred uterus requires avoiding various uterine-related surgeries.