Risk factors and influence of surgical technique on the risk of caesarean scar defect formation: A systematic review of the literature

Objective

To determine the factors associated with an increased risk of cesarean scar defect formation.

Methods

A systematic literature search was performed up to July 2022 in PubMed databases following the PRISMA recommendations. All available English-language clinical studies presenting one or more factors that may affect the risk of cesarean scar defect were included.

Results

39 studies meeting the selection criteria were identified. An association was found between the number of previous cesarean sections and a significant increase in the risk of cesarean scar defect formation. Regarding patient age, gestational age at cesarean section, birth weight and emergency context did not appear to influence the risk of cesarean scar defect. However, cesarean sections performed during labor advanced stages of labor, may increase the risk. The data remain too limited to conclude on the impact of BMI, flexion uterine, and pregnancy pathologies (gestational diabetes, preeclampsia, premature rupture of membranes), the use of oxytocic, or infectious and hemorrhagic complications. Regarding the surgical technique, the literature suggested that a lower hysterotomy is associated with an increased risk of scar defect. However, the single- or double-layer suture technique did not provide a change in risk, and the data were too limited to conclude on the impact of the type of thread or suture used.

Conclusion

The present systematic review of the literature suggests that several factors may increase the risk of developing a cesarean scar defect, such as the number of previous cesarean sections, a cesarean section performed during advanced labor, and a lower hysterotomy. However, the current state of the literature does not allow definitive conclusions to be drawn on most other factors.