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2 . 2022

Delivery outcomes of patients with uterine scar after cesarean section (analysis of the use of extracellular microvesicles of mesenchymal stromal cells)

Abstract

Aim – to carry out a comparative analysis of repeated delivery, the course of the postoperative period in patients with a uterine scar, who underwent exosomes (extracellular microvesicles of mesenchymal stromal cells) during a previous caesarean section, and patients who underwent the first caesarean section without exosomal support.

Material and methods. Group 1 (main) consisted of 60 women, who received 500 µl of EMV MSC intraoperatively during abdominal delivery. Group 2 (control) included: subgroup 2А – 600 women with a uterine scar after caesarean section, who underwent a retrospective analysis of their repeated delivery from 2014 to 2018; subgroup 2В – 100 patients with a uterine scar, who were not injected with exosomes during a prospective study.

Results. The puerperas of the main group had no purulent-septic complications. In the subgroup 2A, in the course of a retrospective analysis, 33/600 (5.5%) puerperas in the postoperative period were diagnosed with endometritis and 23/600 (3.8%) manifestations of lochiometers that required vacuum aspiration. In patients of subgroup 2В the postpartum period was complicated by endometritis in 6/100 (6%) women and in 2/100 2% – lochiometer. In 5/8 (62.5%) patients of the main group, childbirth ended spontaneously. In the comparison groups, these indicators were 21/240 (8.7%) and 4/20 (20%), respectively.

Conclusion. In the course of a prospective study, the high efficiency of intraoperative EMW administration for the formation of a full-fledged scar was shown in comparison with patients without exosomal support. This is indicated by the absence of purulent-septic complications, a significant increase in the thickness of the scar according to MRI and ultrasound. Patients with exosomal support were 7 times more likely to give birth spontaneously compared to subgroup 2A and 3 times more likely than subgroup 2В (62.5, 8.75 and 20%, respectively). The study showed the possibility of using EMV MSCs to reduce the frequency of caesarean section in patients with a scar after abdominal delivery and to prevent placenta ingrowth.

Keywords:extracellular microvesicles; exosomes, abdominal delivery; uterine scar; spontaneous delivery

Funding. The study had no sponsor/grant support.

Conflict of interest. The authors declare no conflict of interest.

Contribution. Collection and processing of material, statistical data processing – Pekareva E.O., Bushueva N.S.; editing – Baranov I.I., Pozdnyakov I.M., Silachev D.N., Sukhikh G.T.; study design – Pekarev O.G., Silachev D.N., Sukhikh G.T.; writing the text – Pekarev O.G.

For citation: Pekareva E.O., Baranov I.I., Pekarev O.G., Silachev D.N., Pozdnyakov I.M., Bushueva N.S., Sukhikh G.T. Delivery outcomes of patients with uterine scar after cesarean section (analysis of the use of extracellular microvesicles of mesenchymal stromal cells). Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2022; 10 (2): 14–22. DOI: https://doi.org/10.33029/2303-9698-2022-10-2-14-22 (in Russian)

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CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

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