{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:56:56Z","timestamp":1791565016896,"version":"4.3.4"},"reference-count":37,"publisher":"Walter de Gruyter GmbH","issue":"8","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2026-0352_abs_001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The human endometrium undergoes repeated cycles of bleeding, inflammation, tissue breakdown, and repair. Unlike most adult tissues, which heal through fibrosis, the endometrium restores its architecture and function after menstruation without scar formation. This capacity for scarless repair is essential for implantation, placentation, and reproductive success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0352_abs_002\">\n                    <jats:title>Content<\/jats:title>\n                    <jats:p>Cesarean delivery creates a deep surgical injury that heals with fibrosis, altered extracellular matrix organization, and abnormal tissue architecture. Cesarean scar defects, cesarean scar pregnancy, and placenta accreta spectrum arise preferentially within these regions of abnormal healing. We examine the possibility that menstruation provides a physiologic model for understanding how the uterus restores tissue architecture without fibrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0352_abs_003\">\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>The contrast between menstrual repair and post-cesarean healing raises a fundamental question: why does one form of uterine injury restore normal architecture while another leads to scar formation? Current discussions of cesarean closure focus largely on mechanical outcomes such as scar thickness and uterine rupture, whereas the biologic determinants of uterine healing remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2026-0352_abs_004\">\n                    <jats:title>Outlook<\/jats:title>\n                    <jats:p>A deeper understanding of the mechanisms that permit scarless repair of the endometrium may provide new opportunities to improve uterine healing after cesarean delivery and reduce the burden of infertility, adenomyosis, cesarean scar pregnancy, and placenta accreta spectrum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2026-0352","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:58:02Z","timestamp":1787673482000},"page":"1263-1267","source":"Crossref","is-referenced-by-count":0,"title":["The endometrium heals without fibrosis after menstruation: implications for uterine healing after cesarean delivery"],"prefix":"10.1515","volume":"54","author":[{"given":"Roberto","family":"Romero","sequence":"first","affiliation":[{"name":"Pregnancy Research Branch, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA"},{"name":"Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA"},{"name":"Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA"},{"name":"Department of Obstetrics and Gynecology , George Washington University, School of Medicine and Health Sciences , Washington , DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Meyyazhagan","sequence":"additional","affiliation":[{"name":"Pregnancy Research Branch, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA"},{"name":"Department of Obstetrics and Gynecology , Wayne State University, School of Medicine , Detroit , MI , USA"},{"name":"Department of Life Sciences , Christ University , Bengaluru , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinnakorn","family":"Chaiworapongsa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University, School of Medicine , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Bujold","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Faculty of Medicine Universit\u00e9 Laval , Quebec City , QC , Canada"},{"name":"Reproductive, Maternal and Child Health Research Axe, Centre Hospitalier Universitaire de Qu\u00e9bec Research Center\u00a0\u2013\u00a0Universit\u00e9 Laval , Quebec City , QC , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agustin Conde","family":"Agudelo","sequence":"additional","affiliation":[{"name":"Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia S.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University, School of Medicine , Detroit , MI , USA"},{"name":"Department of Physiology , Wayne State University School of Medicine , Detroit , MI , USA"},{"name":"Office of Women\u2019s Health, Wayne State University , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awoniyi","family":"Awonuga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University, School of Medicine , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2026100916295036295_j_jpm-2026-0352_ref_001","doi-asserted-by":"crossref","unstructured":"Critchley, HOD, Babayev, E, Bulun, SE, Clark, S, Garcia-Grau, I, Gregersen, PK, et al.. 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