Primary prevention of cesarean section among women with uterine scars after myomectomy
AbstractAim. Define clinical and morphological criteria of scar after miomectomy to form the groups pregnant for the following vaginal.
Material and methods. 115 pregnant women and women in labor after the miomectomy and 60 patients after the transferred myomectomy took part in this prospective research.
Morphometry and study of the condition microcirculation and cytogram of leukocyte in scar of the womb and border tissue; the ultrasonic study of scar after miomectomy and myometrium of intact uteri were used as assessment methods.
Results. The scar a miometrium after a laparotomic miomectomy with a restoration a double-row synthetic seam and after a laparoscopic miomectomy with exstracorporal imposing by a seam represented a thin hem with a parallel arrangement of fibers and individual gemorragiya. Expanded sanguineous vessels were well looked through. The cellular link was presented by individual lymphocytes and neutrophils.
The border between miometrium and a hem after laparotomic miomectomy and laparoscopic with restoration of a bed was hemorrhages. While at a laparoscopic miomectomy with coagulation of a bed the chaotic arrangement of fibers and extensive gemorragiya in hem fabrics took place. The vascular component was presented by a large number of vessels with sclerosis walls. Attracted attention increase in numerical density of all leukocytes, especially neutrophils, and also erythrocytes. The border between miometrium and a hem after a laparoscopic miomectomy with coagulation of a bed was visually presented by large vessels with sclerosis walls, and hemorrhages, and also a set of the small vessels similar to granulations.
From 68 patients with a hem on a uterus, by which conducting childbirth through natural patrimonial ways at 35 was carried out (51.5 %) occurred a spontaneous labor. Repeated operation of Cesarean section is carried out to 33 women (48.5 %). The menacing rupture of a uterus while women in labor after a laparoscopic miomectomy with coagulation have bed in 33.3 % served in structure of indications to the emergency abdominal labor at women with an restoration of a bed the 2nd synthetic seam only in 18.2 % and 15.4 % of cases respectively 1–2 groups the reason.
Conclusion. The carried-out researches showed that if the woman is in reproductive age, it is necessary to carry out a laparotomic miomectomy or a laparoscopic miomectomy, but with obligatory exstracorporal a bed restoration a seam. If the surgeon doesn’t own a technique of laparoscopic suture, to carry out only a classical laparotomic operation. Coagulation of a bed is inadmissible, as during pregnancy the risk of a rupture of a uterus is high.
Keywords:primary prevention, cesarean section, uterine scar, myomectomy, laparotomy, laparoscopy