Causes of development, clinical picture of ectopic pregnancy in the “niche” of the uterine scar after cesarean section

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Abstract
Objective. To determine the risk factors for the development of ectopic pregnancy in the uterine scar “niche” (URN) after cesarean section (CS). Material and methods. Factor analysis of pregnancy in the uterine scar “niche” after CS in 43 patients (main group) was carried out within the framework of the study. The control group consisted of 37 patients with pregnancy in the uterine cavity (n=15) and patients (n=22) with a post-CS uterine scar without signs of anatomical failure. Results. A high risk of pregnancy formation in the uterine scar “niche” was found in 33-37 years old patients with an incompetent uterine scar, who had a history of CS performed 1 year ago or less, chronic endometritis, intrauterine surgeries within the first 1—2 years after CS, 2 CS and more with an interval between them of less than 3 years. Conclusion. Patients with operated uterus have a high probability of repeated abdominal delivery, which increases the area of the scar on the anterior wall of the uterus, contributing to implantation of the fetal egg in the scar projection. The very existence of a uterine scar is a risk factor for pregnancy development in the uterine scar, and against the background of scar failure, the risk of pregnancy development in the scar niche is significantly increased.

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