SUMMARY
Objective. To assess the condition of the uterine scar after cesarean section based on a comprehensive clinical and instrumental evaluation and to determine the optimal mode of delivery. Materials and Methods. A total of 29 pregnant women with a uterine scar at a gestational age of 33–36 weeks were examined. The diagnostic program included clinical and anamnestic assessment, obstetric examination, ultrasonographic evaluation of scar thickness and structure, Doppler assessment of uteroplacental blood flow, cardiotocography, and postpartum hysteroscopy. Statistical analysis was performed using Microsoft Excel and IBM SPSS Statistics 22.0 with descriptive statistical methods. Qualitative variables were presented as absolute values and percentages (%). Results. The mean age of the patients was 28.6 years. All women had a history of one previous cesarean section. The most common pregnancy complications were iron-deficiency anemia (86.2%), threatened miscarriage (13.8%), and preeclampsia (10.3%). In the majority of cases, the uterine scar thickness ranged from 3 to 7 mm and was characterized by smooth contours and homogeneous echostructure; signs of functional scar insufficiency were identified in 3 patients. Vaginal delivery was achieved in 89.7% of cases. The findings confirm that scar thickness alone is not a sufficient criterion for scar integrity and should be evaluated in combination with clinical and Doppler parameters. Conclusion. A comprehensive assessment of the uterine scar condition enables individualized decision-making regarding the mode of delivery and allows for the safe expansion of indications for vaginal birth after cesarean (VBAC).
Keywords: uterine scar, cesarean section, VBAC, ultrasound diagnostics, mode of delivery

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