With the introduction of the “full two-child” policy, many mothers who have had a cesarean section in the past are concerned about the effects of uterine scarring on pregnancy. So, what are the risks of having another pregnancy with a scarred uterus? The main source of uterine scarring can account for more than 95% of the causes of scarred uterus. Other causes of scarred uterus include myomectomy, uterine perforation repair, uterine malformation correction surgery, and tubal interstitial pregnancy surgery. Re-pregnancy with a scarred uterus may bring about serious pregnancy complications. In early pregnancy, there is a risk of cesarean scar site pregnancy (commonly known as uterine incision pregnancy), where the pregnancy tissue is implanted on the scar of the cesarean delivery at the time of pregnancy. If the pregnancy is not diagnosed clearly in time, uncontrollable hemorrhage may occur when terminating the pregnancy, and even forced to remove the uterus, while the incidence of uterine perforation and incomplete miscarriage also increases significantly; in the middle and late stages of pregnancy, the incidence of placenta praevia, placental adhesion implantation, antepartum and postpartum hemorrhage, and uterine rupture also increases significantly, which can endanger the life of mother and child in serious cases. So, what should we pay attention to before and after the second pregnancy, pregnancy and delivery of scarred uterus? First of all, it is generally recommended to use strict contraception for 2 years after cesarean section before another pregnancy, because it takes 2-3 years after the operation for the uterine incision scar to reach a relatively ideal state; contraception is also recommended for 2 years after myomectomy if the uterine cavity was entered during the operation; contraception is generally recommended for 6 months after subplasmic myomectomy; contraception is also recommended for at least 6 months for uterine perforation during abortion. A preconception risk assessment is also recommended for scarred uterus. In the early pregnancy stage, special attention should be paid to exclude the possibility of scar pregnancy, and timely ultrasound must be performed after pregnancy to exclude pregnancy at the scar, and hospitalization is required if scar pregnancy is found in an unplanned pregnancy. For planned pregnancies, regular perinatal care is needed to avoid abdominal impact and extrusion etc. to prevent uterine rupture. It is generally recommended that pregnant women with scarred uterus should always be hospitalized before contractions occur (or follow the doctor’s advice) to avoid tragic out-of-hospital uterine rupture. As for the mode of delivery, it is true that many hospitals are currently terminating pregnancies by cesarean section again, but after strict screening by doctors, some pregnant women with vaginal trial of labor can deliver vaginally without problems.