Abstract
BackgroundCesarean scar pregnancy (CSP) is a late serious complication of cesarean section. There has been an increase in the incidence of CSP worldwide in recent years. It’s a life-threatening condition because of the high risk of uncontrolled hemorrhage and uterine rupture. The mechanism of CSP is still unclear. The endometrial receptivity might be different in the cesarean scar between CSP and normal pregnancies. Endometrial expression of integrin β3 and LIF positively correlates with endometrial receptivity and embryo implantation. The purpose of the study is to explore the mechanism of CSP.MethodsThe EnVision two-step immunohistochemical staining technique was used to detect the expression of integrin β3 and LIF in the decidua of women with CSP (20 cases) and normal pregnancies (20 cases). The distribution and staining intensity of integrin β3 and LIF in the two groups were observed. Observation of the staining were done using microscope within five randomly selected high-power fields (HPF, 10 × 40). All data analyses were conducted with SPSS 17.0 and the statistical significance was set at P <0.05.ResultsThe decidua in the different parts of both two groups that stained with the anti-integrin β3 and anti-LIF antibody: most of the integrin β3 and LIF positive cells were located in glandular epithelium. The expression intensity of integrin β3 in the cesarean scar in CSP group was significant higher than the uterine cavity in CSP group and the cesarean scar in normal pregnancy group. It’s similar with the uterine cavity in normal pregnancy group. The expression intensity of LIF in the cesarean scar in CSP group was significant higher than the uterine cavity in CSP group and the cesarean scar in normal pregnancy group. It’s significant lower than the uterine cavity in normal pregnancy group.ConclusionsThe decidual integrin β3 and LIF might play an important role in the mechanism of CSP. The increase expression of integrin β3 and LIF in the cesarean scar decidua might be associated with embryo implantation in cesarean scar. The occurrence of CSP might be related to the changes of endometrial receptivity in local cesarean scar.
Highlights
Cesarean scar pregnancy (CSP) is a late serious complication of cesarean section
The change of local endometrial receptivity in the cesarean scar might be beneficial to the embryo implantation in CSP patients
This study aimed to: (a) test whether integrin β3 and Leukaemia inhibitory factor (LIF) are localized in cesarean scar decidua in CSP patients; (b) investigate whether decidual integrin β3 and LIF in CSP patients are different from that of healthy controls; and (c) explore the change of endometrial receptivity in the mechanism of CSP
Summary
Cesarean scar pregnancy (CSP) is a late serious complication of cesarean section. A cesarean scar pregnancy (CSP) is defined as a gestational sac located in the scar of a previous cesarean section (CS). It is a late serious complication of CS. Over the past few years, with the rising rate of CS all over the world, there has been an increase in the incidence of CSP worldwide, especially in China [3]. CSP is considered a life-threatening condition because of the high risk of uncontrolled hemorrhage and uterine rupture, which might lead to a hysterectomy, with catastrophic consequences for the patient's reproductive future [4]
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