Сlinical case: uterocervicovaginal fistula as a complication after vaginal metroplasty.

Uterine scar is an area of connective tissue within the myometrium that develops after surgical interventions, trauma, or inflammatory processes. Its formation is accompanied by the replacement of smooth muscle fibers with fibrous tissue, impaired vascularization, innervation, and disruption of myometrial architecture. These changes reduce the functional competence of the uterus and create preconditions for obstetric and gynecological complications. The increasing rate of cesarean section worldwide remains a pressing issue. In 2022, the rate in Russia was 30.1%, which is comparable to North America (32.3%), lower than in Latin America (40.5%) and Turkey (57.2%), but significantly higher than the WHO-recommended level of 10–15%. As a consequence of the rise in abdominal deliveries, there is an increasing number of patients with postoperative uterine scars and specific complications. Among them is the formation of a niche (isthmocele) with thinning of the scar zone (residual myometrial thickness in the scar area 3–2.5 mm according to transvaginal ultrasound). To minimize risks, preconception monitoring is performed, and when indicated, surgical correction (metroplasty) is undertaken. Metroplasty, however, carries the risk of complications, including the rare but clinically significant development of genital fistulas. This article presents a review of a clinical case of a utero-cervico-vaginal fistulathat developed after vaginal metroplasty. According to the patient’s history, she had an isthmocele of the lower uterine segment. After surgical treatment, a spontaneous singleton pregnancy occurred, which ended in abortive expulsion of the gestational sac through the fistulous opening. The patient subsequently underwent repeat surgery at the Department of Operative Gynecology and Gynecologic Oncology with Day Hospital of the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V. I. Krasnopolsky. The procedure aimed to restore the anatomic integrity of the reproductive organs and also served as a stage of preconception preparation for a subsequent pregnancy. This case represents the first description in the literature of such a complication, emphasizing its clinical and scientific significance.