Morphological capability of the uterine scar after the previous caesarean section
Keywords:structure of uterine scar, Caesarean section, morphological study
Purpose of the study was analysis the particulars of morphological capability of the uterine scar after the previous Caesarean section.
Materials and methods. The paper presents the data of morphological study of 100 fragments of uterine scar tissue, which were divided into two groups on clinical grounds. The first group included 50 fragments of the so-called “clinically capable” scars, and the second group included 50 fragments so-called “clinically incapable” scars. Assessment of the uterine scar tissue was performed by immunohistochemical study with monoclonal antibodies, as well as Van Gieson's and Masson's stain.
Study results. More pronounced structural changes of the actual muscle fibers and microcirculatory disorders were observed in form of changes in architecture and areas of myometrium tissue homogenization in the group with “clinically incapable” scars using hematoxylin and eosin stain of the uterine scar tissue. In the differentiation of fibrous connective tissue using Van Gieson's stain method in the group of "clinically incapable" scars were manifested as replacement of muscular tissue with connective tissue with the formation of discrete muscular tissue fibers, and expressed perivascular fibrosis. Degenerative-ischemic changes of uterine scar tissue were found in the group of “clinically incapable” scars using immunohistochemical study with monoclonal antibodies to α-SMA. Pathomorphological study of the uterus scar revealed that hypoxic-degenerative changes and irregularity of maturation of collagen tissue, as well as pronounced replacement of muscle tissue with connective tissue with formation of separately immersed fibers of muscle tissue took place in the “clinically incapable” group. Immunohistochemical study with monoclonal antibodies to α-SMA and to CD31 revealed the more pronounced degenerative ischemic changes in the “clinically incapable” group.
Conclusions. The revealed changes in the structure of the uterine scar tissue indicate that the state of myometrium, vascular component, regenerative capacity in the “clinically incapable” group on 43.4% worse than in the “clinically capable” group, and may manifest negatively with excessive functional loading of the uterine wall during pregnancy and childbirth.
- Serov, V.N., Suhih G.T., ed. Clinical recommendations. Obstetrics and gynecology. 4 еd. Мoscow. GEOTAR-Media (2014): 1024 p.
- Abalos, E., Addo, V., Brocklehurst, P., et al. “Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial.” Lancet 382 (2013): 234–48.
- Ogorodnik, A.O., Davydova, Y.V., Butenko, L.P. “Cesarean section: long-term consequences - "niches" of the postoperative scar.” Perinatology and pediatrics. Ukraine 1.73 (2018): 53–6.
- Voronin, K.V., Chernenko, D.V., Ponomarenko, I.A., Reznichenko, V.V. “Morphofunctional evaluation of the scar on the uterus after caesarean section.” Current problems of obstetrics and gynecology, clinical immunology and medical genetics 11 (2004): 32–7.
- Grigorenko, A.P. “Features of repair of the postoperative scar on the uterus after caesarean section.“ Bulletin of morphology 2 (2000): 272–4.
- Khatib, N., Emad, M., Beloosesky, R., et al. “New model, based on cervical length, predicts successful VBAC.” Am J Obstet Gynecol 212.1 (2015): S195–6.
- Bijde Vaate, A.J., Vander Voet, L.F., Naji, O., et al. “Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review.” Ultrasound Obstet Gynecol 43 (2014): 372–82.
- Perminova, E.I. Pathomorphological analysis of myometriс scars after cesarean section and conservative myomectomy. Thesis abstract for PhD degree, specialty 14.03.02 "Pathological anatomy" and 14.01.01 "Obstetrics and Gynecology". Novosibirsk (2010): 20 p.
- Perepelova, T.A., Gazazyan, M.G., Bezhin, A.I., Ishunina, T.A. “Clinical and morphological assessment of the condition of the lower uterine segment after cesarean section.” Obstetrics, gynecology, reproduction 10.1 (2016): 111–7.
- Bolotova, O.V. Improving the diagnosis of the condition of the scar on the uterus after cesarean section surgery. Thesis abstract for PhD degree, specialty 14.01.01 "Obstetrics and Gynecology". Moscow (2011): 26 p.
- Gyokova, E., Popov, Y., Ivanova-Yoncheva, Y., et al. “Clinical-morphological evaluation of the quality of the uterine scar tissue after caesarean section.” J of IMAB 25.1 (2019): 2433–7.
- Zalevsky, A.V. “A comprehensive assessment of the condition of the uterine scar after cesarean section.” Journal of Obstetrics and Women's Diseases LIX.5 (2010): 118–26.
- Pavlov, R.V., Selkov, S.A., Telegin, I.V. “Features of the morphology and level of cytokines in the tissue of the lower uterine segment during full-term pregnancy and during urgent delivery.” Journal of Obstetrics and Women's Diseases LX.1 (2012): 57–61.
- Jastrow, N., Gauthier, R.J., Gagnon, G., et al. “Impact of labor at prior cesarean on lower uterine segment thickness in subsequent pregnancy.” Am J Obstet Gynecol 202.6 (2010): 563–7.
- Doganay, M., Tongus, E.A., Var, T. “Effects of method of uterine repair on surgical outcome of cesarean delivery.” J Gynecol Obstet 111 (2010): 175–8.
- Aylamazyan, E.K., Andreeva, V.Y., Kuzminykh, T.U., et al. “Optimization of reparative processes of the myometrium after cesarean section (clinical and experimental study).” Journal of Obstetrics and Women's Diseases LXIV.4 (2015): 4–12.
- Atyakshin, D.A., Enkova, E.V., Vukolova, V.A., Ryzhikov, Y.S. “Clinically significant morphological and immunohistochemical features of intact and scar-modified myometrium.” Bulletin of new medical technologies, electronic journal 4 (2018): 57–64.
- Vukolova, V.A., Enkova, E.V. “Assessment of the state of the postoperative scar on the uterus after cesarean section with various stitching techniques.” Journal of Experimental and Clinical Surgery X.3 (2017): 241–5.
- Enkova, E.V., Atyakshin, D.A., Ryzhikov, Y.S., et al. “Prediction of uterine scar failure by evaluating a mast cell population.” Scientific results of biomedical research 5.2 (2019): 86–95.
- Zalesnyi, A.B. “A mathematical model for predicting the state of the uterine scar after cesarean section in practical medicine.” Molodyi Vchenyi 2.3 (2011): 167–72.
- Buyanova, S.N., Schukina, N.A., Chechnev, M.A., et al. “Modern methods for diagnosing insolvency of sutures or scar on the uterus after cesarean section.” Russian Bulletin of the Obstetrician-Gynecologist 1 (2013): 73–7.
- Telegin I.V., Nezhdanov, I.G., Pavlov R.V., et al. “Features of uterine wound repair after cesarean section.” Medical Bulletin of the North Caucasus 8.2 (2013): 89–92.
- Kumar, V., Abbas, A.K., Fausto, N., Aster, J.C. Tissue renewal, regeneration and repair. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia. Saunders/Elsevier (2010): 79–110.
- CAESAR study collaborative group. “Caesarean section surgical techniques: a randomised factorial trial (CAESAR).” BJOG 117.11 (2010): 1366–76.
- Shakila, Y., Joveria, S., Naheed, F. “Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment.” J Coll Physicians Surg Pak 21.9 (2011): 522–6.
- Bujold, E. “The optimal uterine closure technique during cesarean.” N Am J Med Sci 4.8 (2012): 362–3.
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