Background: Uterine scar complications following cesarean delivery represent significant obstetric challenges with potentially severe maternal and neonatal consequences. Objective: To evaluate the incidence, risk factors, and outcomes of uterine scar dehiscence and rupture in post-cesarean pregnancies. Methods: A prospective observational study of 120 women with previous cesarean sections was conducted at a tertiary care center from January to December 2023. Participants underwent standardized antenatal monitoring including serial ultrasonographic assessment. Results: Scar complications occurred in 8.33% (n=10) cases. Short inter-pregnancy interval (<18 months) (adjusted OR 3.8, 95% CI 1.9-7.6, p<0.001) and multiple previous cesareans (adjusted OR 3.2, 95% CI 1.7-6.1, p<0.001) were significant risk factors. Emergency cesarean delivery was required in 90.0% of complicated cases. LUS thickness <2.0mm was associated with higher complication rates (60.0% vs 5.5%, p<0.001). NICU admission rates were significantly higher in complicated cases (40.0% vs 7.3%, p<0.001). Conclusion: Close monitoring of post-cesarean pregnancies, particularly those with identified risk factors, is crucial for optimal outcomes. Ultrasonographic assessment of LUS thickness provides valuable predictive information.