Clinical and morphological parallels of the consistency of the uterine scar after cesarean section

• Evgeniya K. Belyaeva
• Nadezhda M. Startseva
• Nara M. Markaryan
• Marina B. Khamoshina
• Eketerina V. Loginova
• Lyudmila M. Mikhaleva
• Andrey E. Biryukov

Abstract

In recent years, the circle of supporters of the management of childbirth in patients with an operated uterus through the natural birth canal has been expanding. An attempt at vaginal delivery can protect a woman from complications associated with repeated surgery, but requires a comprehensive risk assessment. The existing controversies regarding the tactics of managing patients in this cohort prove that this problem has not yet been found a clear solution and there are many reasons for this: first of all, this is the fear of uterine rupture along the existing scar. In the structure of contraindications for natural childbirth after a cesarean section (СS), the main role is given to assessing the consistency of the uterine scar.

The aim of the study was to improve the criteria for selecting women for vaginal birth after cesarean section.

Material and methods. The study involved 54 patients after repeated CS, who underwent morphological and immunohistochemical examination of excised scars. Retrospectively, based on birth histories, a comparative analysis of clinical and anamnestic factors affecting scar repair was carried out.

Results. During the study it was shown that the healing of a postoperative wound on the uterus was influenced to a greater extent by: complicated course of postoperative period (chances of scar failure were 4.48 times higher), age (3.39 times higher in women aged 35 years and older), presence of extragenital diseases (4.03 times higher), urgency (a history of emergency CS increased the likelihood of the formation of an incompetent scar by 3.53 times).

Keywords:caesarean section; uterine scar; pathological examination; immunohistochemical study

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