Scar tenderness as a sensitive marker for uterine scar dehiscence or uterine rupture.

Objective: To determine the sensitivity, specificity, and diagnostic accuracy of caesarean scar tenderness in predicting uterine dehiscence or rupture during per-operative findings. Methodology: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, JPMC, Karachi, from November 2021 to July 2024. Women with singleton pregnancies having previous caesarean were given Trial of Labor After Caesarean (TOLAC) after informed consent using consecutive sampling. Exclusion criteria included uterine abnormalities, hypertension, diabetes mellitus, multiple pregnancies, and pre-eclampsia. Data were collected on demographic details, clinical findings, and operative outcomes. Statistical analysis was performed using SPSS Version 27. Results: A total of 385 women were included in the study. Scar tenderness was present in 67.8% of women. Uterine rupture was found in 22.3% of cases, while scar dehiscence was present in 49.9%. The sensitivity of scar tenderness in predicting uterine rupture and dehiscence was 85.6%, and the specificity was 78.5%. The positive predictive value (PPV) was 91.2%, and the negative predictive value (NPV) was 67.7%. The overall diagnostic accuracy was 83.6%. Conclusions: Scar tenderness is a useful clinical predictor of uterine scar complications during TOLAC, particularly in low-resource settings.