Clinical Profile and Outcomes of Uterine Scar Tenderness in Cesarean Deliveries: A Retrospective Analysis of 21 Cases Among 353 Women with Varied Parity."

Abstract

Introduction: Uterine scar tenderness during cesarean section is a clinical concern that may reflect compromised scar integrity and influence surgical decision-making. Its assessment is particularly valuable in settings lacking advanced imaging modalities.

Objectives: To investigate the clinical correlates, predictive indicators, and risk modelling of uterine scar tenderness in women undergoing cesarean delivery at Maternity and Children Hospital, Najran, Saudi Arabia.

Methods: A retrospective review was conducted on 353 cesarean cases performed between January 2018 and December 2020. Documented intraoperative scar tenderness served as the primary outcome. Maternal characteristics, neonatal parameters, and placental findings were analyzed. Statistical associations were identified, and a composite risk model was developed based on variables with odds ratios >2.0.

Results: Scar tenderness was recorded in 21 cases (5.95%). Significant maternal correlates included elevated BMI (≥32), high gravidity (≥4), short interpregnancy interval (<18 months), and ≥2 prior cesarean deliveries. Neonatal and placental outcomes were comparable between groups, except for a minor decline in placental weight among those with scar tenderness. The composite model identified six predictive indicators enabling stratification into low, moderate, and high-risk profiles. A novel 3D risk matrix illustrated the convergence of physiological and surgical risk factors in defining scar vulnerability.

Conclusions: This study introduces a clinically meaningful risk stratification approach for uterine scar tenderness in cesarean delivery. Integration of scar tenderness into routine preoperative assessment may enhance individualized obstetric strategies and improve maternal outcomes, especially in resource-limited environments.