Vol. 7, Issue 2, Part A (2025)

Background: Uterine scarring, most commonly from previous cesarean sections or uterine surgeries, is a significant contributor to obstetric complications. With the rising prevalence of cesarean deliveries, understanding the implications of uterine scars on maternal and neonatal outcomes is crucial for optimizing clinical management and reducing associated risks.
Objective: This study aimed to assess and compare maternal and neonatal outcomes in women with and without previous uterine scars and to identify risk factors for uterine rupture and other major complications.
Methods: A retrospective cohort study was conducted at Tikrit Teaching Hospital over a six-month period. A total of 180 pregnant women were enrolled and categorized into two equal groups: 90 women with a history of uterine scars (scarred group) and 90 without (unscarred group). Data on demographic variables, delivery details, complications, and neonatal outcomes were collected from medical records. Statistical analysis was performed using SPSS. Comparative analysis utilized t-tests and chi-square tests, while binary logistic regression identified independent risk factors for uterine rupture.
Results: Women in the scarred group had significantly higher mean age (31.99±1.93 years vs. 25.65±3.38 years, p<0.05) and BMI (29.94±2.91 vs. 24.61±1.72, p<0.01). Cesarean delivery was markedly more frequent in the scarred group (80.69% vs. 19.15%, p<0.001), with longer hospital stays (4.20±0.63 vs. 2.80±0.52 days, p<0.01). Maternal complications such as Placenta Previa (13.33% vs. 2.22%), placenta accreta/percreta (6.67% vs. 0%), uterine rupture (3.33% vs. 0%), postpartum hemorrhage (16.67% vs. 3.33%), and hysterectomy (4.44% vs. 0%) were significantly higher in the scarred group (all p<0.05). Neonatal outcomes were also worse in the scarred group, with significantly more low birth weight infants (20.00% vs. 6.67%), lower mean birth weight (2.85±0.43 kg vs. 3.12±0.37 kg), increased NICU admissions (17.78% vs. 7.78%), and higher incidence of low Apgar scores at 1 minute (11.11% vs. 4.44%) (All p<0.05). Logistic regression identified ≥ 2 prior cesareans (OR=3.24; 95% CI: 1.11-9.42), Placenta Previa (OR=2.89; 95% CI: 1.01-8.31), and short interpregnancy interval < 18 months (OR=2.15; 95% CI: 1.02-4.53) as independent predictors of uterine rupture. Additionally, women with three or more cesareans had the highest rates of Placenta Previa (16%) and uterine rupture (8%).
Conclusion: Prior uterine surgery significantly increases the risk of maternal and neonatal complications, particularly with multiple previous cesarean deliveries. Findings support the need for careful risk stratification, counseling on the mode of delivery, and strategies to minimize primary cesarean rates to improve obstetric outcomes.