{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T19:47:43Z","timestamp":1788637663069,"version":"build-2803163510"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012247","name":"Program of Shanghai Academic\/Technology Research Leader","doi-asserted-by":"publisher","award":["22XD1402000"],"award-info":[{"award-number":["22XD1402000"]}],"id":[{"id":"10.13039\/501100012247","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Secondary infertility following cesarean section is associated with the presence of cesarean section scar defects (CSD). Vaginal repair (VR) is an effective reconstructive surgery for excising CSD, with previous evidence confirming its ability to alleviate menstrual symptoms. To study the pregnancy outcomes of CSD women after VR, we conducted an observational cohort study and analyzed the relationship between clinical characteristics and pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>495 women desiring fertility among 1,085 women with CSD who underwent VR was enrolled between June 2014 and December 2021 in Xinhua Hospital and Shanghai First Maternity &amp;amp; Infant Hospital. All participants had undergone VR and were followed up postoperatively to document menstrual patterns and assess CSD imaging parameters. Additionally, patients\u2019 intentions to conceive post-surgery were recorded, together with follow-up data on pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 495 CSD women desiring fertility, 44.04% achieved subsequent pregnancies following VR. The outcomes included a live birth rate of 75.43%, a miscarriage rate of 18.10%, and no instances of uterine rupture. 58.87% of CSD patients with prior secondary infertility achieved pregnancy. Patients with prior secondary infertility who achieved pregnancy exhibited a higher proportion of optimal healing postoperatively compared to those without pregnancy. Among pregnant women with prior infertility, 78.31% conceived naturally, while 21.69% resorted to\n                      <jats:italic>in vitro<\/jats:italic>\n                      fertilization (IVF). Notably, a higher percentage of the spontaneously pregnancy (SP) group experienced a menstrual duration of less than 7\u202fdays and demonstrated the residual myometrium thickness (TRM) exceeding 5.39\u202fmm post-VR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VR surgery might improve fertility and increase IVF efficacy in CSD patients with secondary infertility. Reaching optimal healing after VR may increase the probability of successful pregnancy and natural conception.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1693754","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:26:50Z","timestamp":1768458410000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pregnancy outcomes in women with cesarean section scar defects and secondary infertility after vaginal repair: a multicenter observational cohort analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Yujia","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huihui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xipeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e235321","DOI":"10.1001\/jamanetworkopen.2023.5321","article-title":"Definition and criteria for diagnosing Cesarean scar disorder","volume":"6","author":"Klein Meuleman","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejogrb.2019.09.001","article-title":"Caesarean scar defect: risk factors and comparison of evaluation efficacy between transvaginal sonography and magnetic resonance imaging","volume":"242","author":"Tang","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1007\/s11136-019-02376-6","article-title":"Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature","volume":"29","author":"Stegwee","year":"2019","journal-title":"Qual Life Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/1471-0528.12542","article-title":"Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding","volume":"121","author":"van der Voet","year":"2013","journal-title":"BJOG"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1016\/j.fertnstert.2009.09.009","article-title":"International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009","volume":"92","author":"Zegers-Hochschild","year":"2009","journal-title":"Fertil Steril"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1111\/1471-0528.14822","article-title":"The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort 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