Background: With the global rise in caesarean deliveries, assessment of uterine scar integrity in subsequent pregnancies has become increasingly important. The integrity of the lower uterine segment (LUS) scar at term plays a crucial role in predicting the risk of uterine dehiscence or rupture during labor. Ultrasonographic evaluation offers a non-invasive approach to assess scar thickness and morphology, potentially guiding obstetric management and improving maternal and fetal safety.

Objectives: This study aimed to evaluate post-caesarean scar characteristics at term using transabdominal sonography and to correlate the ultrasonographic findings with intraoperative grading of the LUS during repeat caesarean section, as well as associated feto-maternal outcomes.

Methods: A prospective observational study was conducted on pregnant women with a history of one prior lower segment caesarean section (LSCS) scheduled for elective repeat LSCS at term. Preoperative transabdominal ultrasound was used to measure LUS scar thickness and assess scar morphology. Intraoperative grading of the LUS was recorded based on visual and tactile assessment. Data on maternal intraoperative complications and neonatal outcomes (Apgar score, birth weight, NICU admission) were collected. Correlation analyses were performed between sonographic scar thickness, intraoperative grading, and perinatal outcomes.

Results: The study demonstrated a statistically significant correlation between reduced sonographic scar thickness (<2.5 mm) and poor intraoperative LUS grading, indicating a thinned or dehiscent scar. Thicker scars (>3.5 mm) were associated with intact uterine walls and favorable maternal and fetal outcomes. No cases of complete uterine rupture were reported. Lower scar thickness also correlated with increased intraoperative blood loss and longer surgical time.