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Abstract

Background: The rising rate of cesarean sections (CS), particularly those performed preterm due to suspected scar tenderness, has raised concerns about clinical decision-making and maternal-fetal outcomes. Scar tenderness is frequently used as an indication for emergency CS; however, the correlation between this clinical symptom and actual intra-operative scar dehiscence remains poorly defined. Additionally, the presence of modifiable maternal risk factors may contribute both to scar tenderness and to the likelihood of early surgical intervention. Objective: To describe Intra-operative findings during caesarean section for suspected scar dehiscence. Study Setting: Department of Obstetrics and Gynecology, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah. Study Duration: Six months from July 09, 2024 to January 08, 2025. Study Design: Cross-sectional descriptive study. Sampling Method: non-probability purposive sampling. Methodology: A total of 100 pregnant women aged 18–45 years, ≥28 weeks gestation, undergoing cesarean section for suspected scar dehiscence were included. Data on demographics, clinical indications, modifiable risk factors (anemia, hypertension, diabetes, infections), and intra-operative findings were recorded. Analysis was performed using SPSS version 24.0 with chi-square, t-tests, and logistic regression to determine statistical significance (p<0.05). Results: Scar tenderness was clinically diagnosed in 49% of patients; however, only 24% showed confirmed scar dehiscence during surgery. A high proportion of participants (64%) underwent preterm cesarean sections, and 55% had a history of two or more previous cesareans. Nearly half (49%) of the women had two or more modifiable risk factors, with anemia (35%), hypertension (26%), infections (30%), and antepartum hemorrhage (29%) being most prevalent. Statistically significant associations were found between these risk factors and both scar tenderness and emergency CS. Notably, many preterm surgeries lacked intraoperative confirmation of scar compromise, raising concerns of overdiagnosis. Conclusion: The study highlights a critical gap between clinical assessment and intraoperative reality regarding scar integrity. Many cesarean sections performed due to suspected scar dehiscence may be avoidable through more objective evaluation methods and effective management of modifiable risk factors. These findings underscore the need for improved clinical guidelines, antenatal risk screening, and health education strategies to optimize CS timing and reduce maternal morbidity. Future research should focus on prospective validation of scar assessment tools and the development of intervention models tailored to high-risk obstetric populations.