# Caesarean Section Scar and Placental Location at the First Trimester of Pregnancy—A Prospective Longitudinal Study

## TL;DR

This study examines how the number of previous caesarean sections and the presence of a scar niche affect placental location in early pregnancy.

## Contribution

The study provides new insights into the relationship between caesarean scar characteristics and early placental positioning.

## Key findings

- The placenta was low-lying in 77.4% of women with one previous caesarean section.
- The presence of a caesarean scar niche did not significantly affect the incidence of low-lying placentas.
- The number of previous caesarean sections had no significant impact on placental location in the first trimester.

## Abstract

Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11–14 weeks. The CS scar niche (“defect”) was bordered in the sagittal plane as a notch at the previous CS scar’s site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect (“niche”) was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas.