An Innovative Approach to Studying the State of the Uterine Scar after Cesarean Section on the Basis of a Comparative Study

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Abstract

Background. Today we have not really highly informative methods for assessing the state of the uterine scar. This fact does not allow us to formulate clear selection criteria for spontaneous delivery for patients who had cesarean section (CS). The result of the formulated problem is not only an increase in the frequency of repeated abdominal delivery, but also a fivefold increase in the risks of intraoperative and postoperative complications for women of reproductive age. Aims — explore the property, structure and morphological features of the myometrial scar tissue by developing a physical model based on morphological predictors. Materials and methods. The study included 49 women who ahead a second caesarean section in the maternity hospital at the S.S. Yudin state medical center. The patients had scar tissue excised in the lower uterine segment and the resulting biopsies were divided into 2 fragments. The first fragment of biopsies was necessary for performing a morphological study, based on the results of which randomization was carried out into groups. The main group included 24 fragments, where the scar tissue was well-established, and the comparison group included 25 fragments, where according to morphological research, signs of its insolvency were revealed. Further assessment of the scar state was performed using the second fragment of biopsies by creating a physical model of the study, on the basis of which the dependence of elongation on the applied force was estimated. The study was conducted in the laboratory of scientific research on the development of bioprostheses of the CSSC A.N. Bakuleva. Results. Based on a morphological study, it was confirmed that the failure of the scar is based on the disorganization of connective tissue, indicating the possible presence of undifferentiated connective tissue dysplasia for the patient. The physical model of the study demonstrated that the presence of such a difficult-to-diagnose pathology leads to a decrease in the elasticity, and therefore-the strength and elasticity of the scar on the uterus. Conclusions. For this period of time, we need to improve methods for assessing the condition of the uterine scar in order to resolve the issue of the possibility of conducting natural childbirth for patients after undergoing CS surgery. It is possible that the created physical model will be able to evaluate the predictive ability of ultrasonic elastography within the framework of this problem. It is important to remember that scar formation is the final stage of regeneration, therefore, the maximum number of answers to a detailed study of morphological and immunohistochemical features of the myometrium, as it is the primary matrix on which will be the formation of scar tissue.

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Alexander N. Strizhakov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: kafedra-agp@mail.ru
ORCID iD: 0000-0001-7718-7465

MD, PhD, Professor, Academician of the RAS

Russian Federation, 8/2, Trubeckaya str., Moscow, 119991

Irina V. Ignatko

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: iradocent@mail.ru
ORCID iD: 0000-0002-9945-3848
SPIN-code: 8073-1817
Scopus Author ID: 15118951800

MD, PhD, Professor, Corresponding Member of the RAS

Russian Federation, 8/2, Trubeckaya str., Moscow, 119991

Anastsia A. Churganova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: churganova1@rambler.ru
SPIN-code: 3872-7167

MD, PhD, Assistant

Russian Federation, 8/2, Trubeckaya str., Moscow, 119991

Alexandr G. Aslanov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: kafedra-agp@mail.ru
ORCID iD: 0000-0002-6611-2211
SPIN-code: 2491-6375

MD, PhD, Associate Professor

Russian Federation, 8/2, Trubeckaya str., Moscow, 119991

References

  1. Цхай В.Б. Непридуманные случаи из практики // StatusPraesens. Гинекология, акушерство, бесплодный брак. — 2016. — № 1. — С. 111–115. [Tskhai VB. Nepridumannye sluchai iz praktiki. StatusPraesens. Ginekologiya, akusherstvo, besplodnyi brak. 2016;(1):111–115. (In Russ.)]
  2. Шмаков Р.Г., Баев О.Р., Пекарев О.Г., и др. Кесарево сечение: показания, хирургическая техника, методы обезболивания. — М.: Центр полиграфических услуг «РАДУГА», 2016. [Shmakov RG, Baev OR, Pekarev OG, et al. Kesarevo sechenie: pokazaniya, khirurgicheskaya tekhnika, metody obezbolivaniya. Moscow: Center for Printing Services “RADUGA”; 2016. (In Russ.)]
  3. Осипенкова Т.К., Демура Т.А. Мальформация и дезорганизация рубца в стенке матки на фоне недифференцированной дисплазии соединительной ткани — причина разрыва стенки беременной матки // Акушерство и гинекология. — 2016. — № 7. — С. 105–110. [Osipenkova TK, Demura TA. Scar malformation and disorganization in the uterine wall in the presence of undifferentiated connective tissue dysplasia are a cause of pregnant uterine wall rupture. Akusherstvo i ginecologiya = Obstetrics and gynecology. 2016;(7):105–110. (In Russ.)] doi: https://doi.org/10.18565/aig.2016.7.105-110
  4. Юсупов К.Ф., Недопекина Е.В., Вихарева О.Н. Применение метода эластографии в акушерско-гинекологической практике // Акушерство и гинекология. — 2016. — № 11. — С. 22–27. [Yusupov KF, Nedopekina EV, Vikhareva ON. Use of elastography in obstetric and gynecological practice. Akusherstvo i ginecologiya = Obstetrics and Gynecology. 2016;(11):22–27. (In Russ.)] doi: https://doi.org/10.18565/aig.2016.11.22-7
  5. Приходько А.М., Баев О.Р., Карапетян А.О., и др. Особенности состояния миометрия при кесаревом сечении с учетом излития околоплодных вод и родовой деятельности. Клинико-морфологическое исследование // Акушерство и гинекология. — 2018. — № 4. — С. 1–13. [Prikhodko AM, Baev OR, Karapetyan AO, et al. Features of the myometrial status during cesarean section with regard to amniorrhea and birth activity: A clinical and morphological study. Akusherstvo i ginecologiya = Obstetrics and Gynecology. 2018;(4):1–13. (In Russ.)] doi: https://doi.org/10.18565/aig.2018.4.50-57
  6. Schelbert EB, Sabbah HN, Butler J, Gheorghiade M. Employing extracellular volume cardiovascular magnetic resonance measures of myocardial fibrosis to foster novel therapeutics. Circ Cardiovasc Imaging. 2017;10(6):e005619. doi: https://doi.org/10.1161/CIRCIMAGING.116.005619
  7. Tang X, Wang J, Du Y, et al. Caesarean scar defect: risk factors and comparison of evaluation efficacy between transvaginal sonography and magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2019;242:1–6. doi: https://doi.org/10.1016/j.ejogrb.2019.09.001
  8. Park IY, Kim MR, Lee HN, et al. Risk factors for Korean women to develop an isthmocele after a cesarean section. BMC Pregnancy Childbirth. 2018;18(1):162. doi: https://doi.org/10.1186/s12884-018-1821-2
  9. Nezhat C, Grace L, Soliemannjad R, et al. Cesarean scar defect: What is it and how should it be treated? OBG Management. 2016;28(4):32,34,36,38–39,53.
  10. Stegwee SI, Jordans IPM, van der Voet LF, et al. Single-versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development the 2Close study: A multicentre randomised controlled trial. BMC Pregnancy Childbirth. 2019;19(1):85. doi: https://doi.org/10.1186/s12884-019-2221-y

Supplementary files

Supplementary Files
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1. Rice. 1. Indications for the first cesarean section,%

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2. Fig. 2. Morphological characteristics of scar tissue in the main group and the comparison group: A – B - incompetent scar: A - extensive area of ​​connective tissue disorganization (staining with hematoxylin and eosin, × 250); B - ruptures of smooth muscle elements and a pronounced inflammatory reaction (staining with hematoxylin and eosin, × 250); B - extensive areas of disorganization of connective tissue (painted in red, staining according to van Gieson, × 250); D, D - a well-to-do scar: D - smooth muscle elements are located compactly (stained with hematoxylin and eosin, × 250); D - an area of ​​connective tissue with minor signs of disorganization, the inflammatory reaction is moderately expressed (staining with hematoxylin and eosin, × 250). А – В - comparison group. D, D - the main group.

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3. Fig 3. Morphological features of the state of connective tissue in the comparison group and the main group (Mason stain, × 250): A - incompetent scar (signs of disorganization of connective tissue - a large number of white areas); B - a well-to-do scar (the connective tissue is located compactly). A - equal group, B - main group.

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4. Fig 4. Typical deformation curves of an insolvent (A) and a consistent (B) scar. 1-3 - the number of strips that were obtained from one biopsy (sample) of scar tissue

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