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1 . 2023

Possible complications during repeated cesarean section and their prevention


An important problem of modern obstetrics is the prevalence of cesarean section delivery (up to 40% of the total number of births), in respect of which there is no tendency to decrease. The consistently high frequency of operative delivery is associated, among other things, with a high percentage of repeated caesarean sections in the group of women with an uterine scar. Despite the globally recognized possibility of vaginal delivery in women with an uterine scar, they are performed in only about 1% of cases. At the same time, most practicing obstetricians and gynecologists consider a relatively safe method of delivery by caesarean section in modern obstetrics and continue to insist on repeated surgical intervention.

On the basis of literature data, complications of repeated cesarean section were analyzed, and an increase in the number of intraoperative complications associated with an increase in the number of caesarean sections was estimated. It was concluded that the risk of a number of complications increases in proportion to the number of caesarean sections performed. This article proposes methods for the prevention of intraoperative complications, such as bladder injury and continuation of the incision on the uterus into the gap during fetal extraction during repeated caesarean section, which are used in the maternity hospital of the BSMU Clinic.

Keywords:cesarean section; uterine scar; complications; bladder injury

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Kudryashova K.V., Yashchuk A.G., Musin I.I. Possible complications during repeated cesarean section and their prevention. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11 (1): 28–32. DOI: (in Russian)


1. Postoperative scar on the uterus, requiring the provision of medical care to the mother during pregnancy, childbirth and the postpartum period. Clinical guidelines. ROAG, 2021. (in Russian)

2. Risager J.K., Uldbjerg N., Glavind J. Cesarean scar thickness in non-pregnant women as a risk factor for uterine rupture. J Matern Fetal Neonatal Med. 2022; 35 (2): 389–94.

3. Wang L.L., Chen J.Y., Yang H.X., Fan L.X., Zhang X.X., Jing B.H., et al. Correlation between uterine scars during pregnancy and uterine rupture in pregnant women who are pregnant again after cesarean section. Chin J Obstet Gynecol. 2019; 54 (6): 375–80.

4. Venturella R., Quaresima P., Micieli M., Rania E., Palumbo A., Visconti F., et al. Non-obstetrical indications for cesarean section: A state-of-the-art review. Arch Gynecol Obstet. 2018; 298 (1): 9–16.

5. Gungorduk K., Asicioglu O., Celikkol O., et al. Iatrogenic bladder injuries during caesarean delivery: A case control study. J Obstet Gynaecol. 2010; 30 (7): 667–70.

6. Lee J.S., Choe J.H., Lee H.S., et al. Urologic complications following obstetric and gynecologic surgery. Korean J Urol. 2012; 53 (11): 795–9.

7. Oliphant S.S., Bochenska K., Tolge M.E., et al. Maternal lower urinary tract injury at the time of Cesarean delivery. Int Urogynecol J. 2014; 25 (12): 1709–14.

8. Chill H.H., Karavani G., Reuveni-Salzman A., Lipschuetz M., Shimonovitz T., Cohen N., et al. Urinary bladder injury during cesarean delivery: risk factors and the role of retrograde bladder filling. Int Urogynecol J. 2021; 32 (7): 1801–6.

9. Matsubara S. Caesarean hysterectomy for placenta praevia accreta: filling the bladder technique to identify an appropriate bladder separation site. J Obstet Gynaecol. 2013; 33 (2): 163–4.

10. Vuchenovich Yu.D., Novikova V.A., Kostin I.N., Radzinsky V.E. Risks of scar failure and attempted vaginal delivery after caesarean section. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2019; 7 (3). Supplement: 93–100. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

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