Ranking of Risk Factors Leading to Uterine Scar Defect-Systematic Online Review

Background: Cesarean deliveries have increased in recent years worldwide. This increase translates into an escalation of obstetrical complications that could lead to permanent injuries. Comprehensive knowledge of the risk factors for uterine scar defects and their probability factor could guide gynecologists towards decreasing the percentage of scar defects and reducing the morbidity produced by a scarred uterus. Methods: A review of the literature published in the last 10 years produced a number of 80,085 articles, from which we screened 147 articles and selected 11 recently published papers, attempting to rank the most frequently described risk factors in terms of probability. A total number of 11,349 patients who underwent CS were included from the 11 studies. Results: Cesarean scar defects developed in 19.42% of cases; our results showed that the highest probability was given by single-layer suture, with gestational diabetes being the main patient-related risk factor for scar defects. A definitive ranking of the risks is difficult to assess, because different studies focus on certain risks and most of the relevant data are missing or are omitted. Conclusions: In this study, we investigate the most common risk factors that give rise to the development of cesarian scar defects, conducting a ranking of these risks from the most probable to the least important, in order to facilitate informed decision making for providers.