Uterocervicovaginal fistula as a complication after vaginal metroplasty

A uterine scar is a connective tissue area in the myometrium that results from surgical intervention, injury, or inflammation. It is characterized by the replacement of smooth muscle fibers with fibrous tissue, as well as abnormalities in myometrial vascularization, innervation, and architecture. These abnormal changes impair the function of the uterus and increase the risk of obstetric and gynecological complications. The rising global cesarean section rates continue to be a major concern. In Russia, they were 30.1% in 2022, which is comparable to North America (32.3%), lower than in Latin America (40.5%) and Turkey (57.2%), but considerably higher than the WHO-recommended threshold of 10%–15%. As cesarean section rates increase, so does the number of patients with postoperative uterine scars and specific complications. These complications include isthmocele with myometrial thinning at the scar site (residual myometrial thickness at the scar site 3–2.5 mm on ultrasound). Preconception monitoring is used to minimize risks, with surgical treatment (metroplasty) as indicated. Metroplasty, however, carries the risk of complications such as genital fistulas, which are uncommon but clinically significant. This article presents a clinical case of a uterocervicovaginal fistula after vaginal metroplasty. According to the medical history, a patient with uterine isthmocele in the lower segment had a spontaneous singleton pregnancy after surgical treatment. The pregnancy ended in abortion with expulsion of the gestational sac through the fistulous opening. The patient underwent repeat surgery at the Department of Operative Gynecology and Gynecologic Oncology with Day Hospital, V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. The procedure aimed to restore the anatomic integrity of the reproductive organs and to provide preconception care for a future pregnancy. This is the first published report of this complication, highlighting its clinical and scientific significance.