Uterine Scar Research Articles

The Effects of Uterine Closure Techniques Single Layer Locking, Modified Lembert, and Laterally Continuing Suture on Uterine Scar Development: A Cohort Research

The Effects of Uterine Closure Techniques Single Layer Locking, Modified Lembert, and Laterally Continuing Suture on Uterine Scar Development: A Cohort Research

Improvement of endometrial thickness and in vitro fertilization outcomes in patients with Asherman's refractory endometrium using autologous mesenchymal stem cells from the stromal vascular fraction.

Patients with Asherman's Syndrome (AS) and an endometrial thickness (EMT) less than 7 mm are infertile women with suboptimal endometrium due to uterine scarring or endometrial atrophy. This study aimed to examine the effect of intrauterine injections of adipose-derived mesenchymal stem cells (ADMSC) from the Stromal Vascular Fraction (SVF) of adipose tissue on EMT and in vitro fertilization (IVF) outcomes: which are improvements in EMT and pregnancy rates. This double-arm retrospective study included 41 AS patients with hysteroscopic adhesiolysis. Twenty-one patients with AS refractory endometrium (Group 2) were given ADMSC to improve EMT, and 20 non-treated, age-matched patients served as controls (Group 1). For Group 2, SVF was isolated from 15 ml of adipose tissue and transmyometrial injected into the patient's uterine cavity. For all patients, EMT was examined using ultrasound before embryo transfer. In Group 2, after ADMSC treatment, EMT significantly improved (3.2 ± 1.8 mm, P<0.001). Afterward, three patients spontaneously became pregnant, and eighteen underwent frozen embryo transfer. A significant increase in implantation (66.7% vs. 4.8%, P = 0.002) and live birth rates (0.0% vs. 47.6%, P = 0.001) were recorded. No significant difference was observed in EMT, cycle implantation, or clinical pregnancy between the two groups, but the live birth rate in Group 2 after ADMSC treatment was higher than in Group 1. The results demonstrate that autologous intrauterine ADMSC injection can improve EMT, implantation, and pregnancy rates in AS patients with refractory endometrium. This research underscores the life-changing potential of autologous ADMSC treatment for patients with refractory endometrium, providing a promising avenue for future treatments.

Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)

BackgroundThe rising rate of cesarean sections (CS) has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecological complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. ObjectiveWe aim to evaluate the effect of single- versus double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecological, fertility and obstetric outcomes at the same follow-up. Study DesignA multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years undergoing a first CS were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate with secondary outcomes including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetric and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). ResultsBetween 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830/1144 and 818/1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates, also no differences in pregnancy rate, need for fertility treatments, mode of delivery or uterine ruptures in subsequent pregnancies. High rates of gynecological symptoms including spotting (30-32%), dysmenorrhea (47-49%) and sexual dysfunction (FSFI score 23)-are reported in both groups. ConclusionThe study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first CS. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecological symptoms after a CS should be discussed with patients.

Cesarean Scar Ectopic Pregnancy: Experience From Benghazi Medical Center, 2022

Background: Cesarean scar pregnancy (CSP) is a rare consequence of a previous cesarean delivery and a new type of ectopic pregnancy, but it is life-threatening if unrecognized and inadequately managed. Despite the rising incidence of CSP, there are no consensus or evidence-based guidelines for management. Aims: To review risk factors, clinical features, diagnostic methods, and management of women with CSP at Benghazi Medical Center. Materials and methods: A descriptive-case series study of CSP cases between the Ist of March 2018 and Ist of April 2022.. Data collected retrospectively. The data included demographics, presenting symptoms and signs, ultrasound findings, treatment used, and any complications. Results: The total number of ectopic pregnancies in period between 1st March 2018 and 1st April 2022 was 262, ten women (3.82%) were diagnosed as scar ectopic, The women's ages ranged from 28 to 47 years, about 60% had three or four previous cesarean scars, abdominal pain with vaginal bleeding was in 30% of the cases, while 60% of patients were asymptomatic and all patients were stable during the diagnosis, except for one case that had signs of shock. ultrasound finding was 80% presence of gestational sac implanted low near the previous scar; initial diagnosis was delayed by 50%. The management was laparotomy and gestational sac excision in four cases that did not require further treatment, dilatation and uterine evacuation were done in two cases that required use of uterine balloon to control bleeding and further use of methotrexate In one case (10%), systemic methotrexate alone was effective. Severe bleeding was seen among 60% of women, and 20% underwent hysterectomy. The complications were significantly (P&lt; 0.05) more common among women with high parity and also in cases where there was no intervention during the diagnosis. Conclusion: A previous uterine scar is the main risk factor for CSP; there is no specific clinical feature for CSP; ultrasound is used for the diagnosis; surgical management appears to be a better option, serious complications were seen mainly when no intervention was done during the diagnosis.

Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.

A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of "en bloc" excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien-Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.

Comparative analysis of pharmacologic and mechanical methods for labor induction in patients at full-term pregnancy—A systematic review

Background Induction of labor is performed for either maternal or fetal indications to reduce perinatal morbidity and mortality without increasing maternal morbidity. The aim of this study was to review the scientific literature regarding induction of labor in patients with full-term pregnancy and create a systematic review of the literature to answer the question: “In patients with full-term gestation - does combining the Foley balloon with dinoprostone for the artificial induction of labor - offer better perinatal results over time from the application of the labor induction method until birth?”. Methods A literature search was performed on 23/08/2023 in the PubMed database; only articles published within the past 5 years were considered. We included articles in which labor was triggered with a vaginal device with dinoprostone, oxytocin, and/or a Foley catheter in full-term patients who met the following criteria: monofetal pregnancy, cranial presentation, intact membranes, and no history of uterine scar. We used the keywords “induction,” “labour,” “term,” “Foley,” “dinoproston,” “oxytocin.” Results The Pubmed database currently has approximately 20,000 scientific papers about labor induction. Only two studies met the proposed criteria. Considering the small volume of eligible data for the proposed research, the main meta-analysis addressing the topic was also considered. Conclusions The use of dinoprostone and oxytocin infusion is effective for triggering labor under conditions of compliance with obstetrical indications and pharmacological characteristics. Studies that compare the success of artificial induction of labor with Foley balloon and Foley+dinoprostone in patients with full term gestation are limited, but nevertheless, the association of Foley balloon with artificial induction with dinoprostone seems to be a cost-effective method. The limited number of scientific studies on this topic determines a risk of bias, inconsistency and imprecision, and for the future, we propose to carry out a randomized prospective study to study the topic.

РАЗРЫВ НЕОПЕРИРОВАННОЙ МАТКИ В ПЕРВОЙ ПОЛОВИНЕ БЕРЕМЕННОСТИ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Abstract. Introduction. Uterine rupture is a rare and life-threatening complication for patient and fetus. This pathology is mostly associated with pregnancy and occurs in late preterm periods, but there are also some cases of non-pregnant uterus ruptures described. Aim. This study is aimed at showing and analyzing the importance of uterine ruptures, even without any uterine scars and in the first half of pregnancy. Materials and Methods. This paper describes the clinical case of a multigravida patient with the rupture of unscarred uterus in the second trimester of pregnancy. Results and Discussion. A 32-year-old female patient was admitted to the department of gynecology at the gestational age of 16 weeks, complaining of severe abdominal pains, with the signs of intraabdominal bleeding. Histopathic rupture of the uterus was detected in the emergency laparotomy. Conclusions. Absence of uterine scars does not prevent from potential rupture of the uterus Timely diagnosis is necessary, and an emergency surgical intervention must be performed to save the patient’s life at any suspicion on uterine rupture. Even with early pregnancies, uterine rupture risks must be considered, especially regarding women with a history of uterine cavity surgeries. There is a question of the necessity to perform elective hysteroscopy during pregnancy planning to patients with the past history of uterine curettage

Outcomes of the Expectant Management of 10 Cesarean Scar Pregnancy Cases in Patients Who Refused the Termination of Pregnancy.

Expectant management of cesarean scar pregnancy (CSP) in patients who refuse termination of pregnancy and continue with placenta accreta spectrum (PAS) is possible with multidisciplinary care and careful monitoring in a tertiary care center. Doctors with the relevant expertise in managing PAS use highly accurate ultrasound as a tool to diagnose, monitor, and manage this disorder, which enables them to determine appropriate surgical strategies and techniques to achieve optimum maternal and fetal outcomes with minimal blood loss and no major maternal mortality and morbidity. In this study, we aim to evaluate expectant management in such patients. This is a retrospective study of 10 patients with a previous history of a uterine scar. Diagnosed with CSP in the first trimester, they refused to terminate their pregnancy and continued with PAS. We studied them over a period of four years from 2018 to 2022 and managed them at Latifa Hospital, Dubai, UAE. Of the 10 patients, nine delivered in the third trimester (around 34 weeks gestation), seven underwent elective surgery, and three underwent emergency surgery. Four patients were exogenous cases and six were endogenous cases at diagnosis during early gestation. Seven patients had a cesarean hysterectomy, and three (with focal placenta accreta) had uterine wall reconstruction surgery. Four patients needed blood transfusions. The average duration of surgery was between 2.5 and 5 hours. There were no miscarriages, no maternal and neonatal deaths, and no significant obstetric complications such as rupture of the uterus or major obstetric hemorrhage. Even though CSP is a potentially life-threatening condition because of serious complications such as PAS if continued, expectant management is possible under multidisciplinary care where the team strictly adheres to clinical protocols and accurate surgery to reduce obstetric hemorrhage.

Uterine scars after caesarean delivery: From histology to the molecular and ultrastructural level.

Uterine rupture during a trial of labor after caesarean delivery (CD) is a serious complication for mother and fetus. The lack of knowledge on histological features and molecular pathways of uterine wound healing has hindered research in this area from evolving over time. We analysed collagen content and turnover in uterine scars on a histological, molecular and ultrastructural level. Therefore, tissue samples from the lower uterine segment were obtained during CD from 16 pregnant women with at least one previous CD, from 16 pregnant women without previous CD, and from 16 non-pregnant premenopausal women after hysterectomy for a benign disease. Histomorphometrical collagen quantification showed, that the collagen content of the scar area in uterine wall specimens after previous CD was significantly higher than in the unscarred myometrium of the same women and the control groups. Quantitative real-time PCR of uterine scar tissue from FFPE samples delineated by laser microdissection yielded a significantly higher COL3A1 expression and a significantly lower COL1A2/COL3A1 ratio in scarred uteri than in samples from unscarred uteri. Histological collagen content and the expression of COL1A2 and COL3A1 were positively correlated, while COL1A2/COL3A1 ratio was negatively correlated with the histological collagen content. Transmission electron microscopy revealed a destroyed myometrial ultrastructure in uterine scars with increased collagen density. We conclude that the high collagen content in uterine scars results from an ongoing overexpression of collagen I and III. This is a proof of concept to enable further analyses of specific factors that mediate uterine wound healing.

Prior Cesarean Birth and Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol: A Systematic Review and Meta-analysis.

To assess the risk difference of uterine rupture when using current mifepristone and misoprostol regimens for second-trimester abortion among individuals with prior cesarean birth compared with those without prior cesarean birth. We searched the terms second trimester, induction, mifepristone, and abortion in PubMed, EMBASE, POPLINE, ClinicalTrials.gov , and Cochrane Library from inception until December 2022. We included randomized trials and observational studies including a mixed cohort, with and without uterine scar, of individuals at 14-28 weeks of gestation who used mifepristone and misoprostol to end a pregnancy or to manage a fetal death. We excluded case reports, narrative reviews, and studies not published in English. Two reviewers independently screened studies. Absolute risks with binomial CIs were calculated from pooled data. Using R software, we estimated total risk difference by the Mantel-Haenszel random-effects method without continuity correction. For studies with zero events, a continuity correction of 0.5 was applied for individual risk differences and plotted graphically with forest plots. Statistical heterogeneity was assessed with Higgins I2 statistics. Funnel plot assessed for publication bias. Of 198 articles identified, 22 met the inclusion criteria: seven randomized trials (n=923) and 15 observational studies (n=6,195). Uterine rupture risk with prior cesarean birth was 1.1% (10/874) (95% CI 0.6-2.1) and without prior cesarean birth was 0.01% (2/6,244) (95% CI 0.0-0.12). The risk difference was 1.23% (95% CI 0.46-2.00, I2 =0%). Of the 12 reported uterine ruptures, three resulted in hysterectomy. Uterine rupture with mifepristone and misoprostol use during second-trimester induction abortion is rare, with the risk increased to 1% in individuals with prior cesarean birth. PROSPERO, CRD42022302626.

Successful uncomplicated vaginal birth in patient with 4 previous cesarean sections at obstetrics and gynecology hospital in Damascus, Syria: A case report

Background: Since the vaginal birth is the best recommended rout of delivery with a lower mortality and morbidity for mothers and babies compared with repeat CS, a successful vaginal delivery after one or more cesarean sections has been reported, but the risks and benefits of trial of vaginal labor should be determined previously. Case presentation: In this study we report a case of 30-year-old woman with 4 previous cesarean sections who was admitted with preterm labor, the fetal head was crowning so it was safer to proceed with vaginal delivery. Although the baby was preterm there was no maternal and neonatal morbidity and mortality and the uterine scar was intact. Conclusions: VBAC may be suggested as an option to lower CS and its complications especially in low resources countries, after doing risk-benefit assessment first.

Adipocytes in the Uterine Wall during Experimental Healing and in Cesarean Scars during Pregnancy.

We have suggested that adipocytes in uterine scars may affect the development of the placenta accrete spectrum (PAS). In the experimental part, we explored adipocytes in the uterine wall by the twelfth sexual cycle after surgery. In the clinical part, we investigated adipocyte clusters in the cesarean scar of pregnant women with and without PAS. The uterine wall was evaluated in gross and histological sections using morphometry, histochemistry (hematoxylin and eosin stain, Mallory stain), and immunohistochemistry for FABP4 (adipocyte markers), CD68, CD163, CD206 (macrophages), CD 34 (endothelium), cytokeratin 8 (epithelium), aSMA (smooth muscle cells). The design included an experimental study on Sprague-Dawley rats (n = 18) after a full-thickness surgical incision on the seventh (n = 6), 30th (n = 6), and 60th day (n = 6). The clinical groups include pregnant women without uterine scars (n = 10), pregnant women with a uterine scar after previous cesarean sections (n = 10), and women with PAS (n = 11). Statistical processing was carried out using nonparametric methods. Comparisons were conducted using the Mann-Whitney U-test and Kruskal-Wallis test. Statistical significance was considered at p < 0.05. On the seventh day, the rat uterine horn was enveloped by adipose tissue, which contained crown-like structures with FABP4+, CD68+, CD206+, and CD163+ cells. FABP4+ cells in the uterine wall were absent by the 30th day. The number of CD206+ and CD163+ cells in the adipose tissue decreased by the 30th day. On the 60th day, the attachment of fat tissue was revealed in the form of single strands. The serous layer around the damaged area totally recovered on the 60th day. FABP4+ cells were not detected in the uterine wall samples from pregnant women without a previous cesarean section. Adipocytes were found in the scar during non-complicated pregnancy and with PAS. Reducing the number of CD68+ cells in adipocyte clusters, there were in myometrium with PAS. Increased CD206+ and CD163+ cells were revealed in uterine adipocyte clusters of the group. According to the experimental finding, adipocytes should be absent in the uterine wall by the 12th sexual cycle after a full-thickness surgical incision. The presence of adipocyte clusters in cesarean scar indicated the disturbance of cell interaction. Differences in the numbers of CD206 and CD163 cells in adipocyte clusters between groups with and without PAS may be indirect evidence that uterine adipocytes affect the development of PAS.

Transvaginal Ultrasound Evaluation Of Cesarean Section Niche Scar During Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To determine the prevalence of a CS scar niche during pregnancy using transvaginal ultrasound imaging, and to determine the relationship between the evolution of the CS scar niche and the ultimate pregnancy result. Materials and Methods: Transvaginal sonography was used in this prospective observational research to look at the uterine scars of 100 women at 11+0-13+6, 18+0-20+6 and 32+0-35+6 weeks of pregnancy. When the region of hypoechogenic myometrial discontinuity of the lower uterine section was discovered, a scar was discernible while pregnant. An indentation at the location of the CS scar with a depth of at least 2 mm in the sagittal axis was designated as the CS scar niche (or "defect"). Myometrial thickness next to the niche and the remaining myometrial thickness were used to quantify the hypoechogenic portion of the CS niche in two dimensions. (RMT). The entire lower uterine segment (LUS) thickness and the myometrial layer thickness were measured during the second and third trimesters of pregnancy at the thinnest portion of the scar area. In a non-selected subset of patients (n=20), CS scars were measured by two separate examiners. Scar visibility was evaluated using descriptive analysis, and the intraclass correlation coefficient (ICC) was computed to demonstrate the degree of absolute agreement between two observers for measuring scars. Maternal age, BMI, smoking status, prior vaginal deliveries, obstetric complications, and a history of uterine curettage were among the factors looked into as potential contributors to the CS scar niche. The hospital's computerized medical database provided clinical statistics on pregnancy outcomes and complications. Results: 80.9% of the ladies could see the scar. A CS scar niche was prevalent in 53.6% of people with a noticeable CS scar. Excellent intra- and interobserver agreement was observed for CS scar niche readings. There was no statistically significant correlation between maternal age, BMI, gestational diabetes, smoking status, previous vaginal delivery after CS, and niche development when subgroups of women were compared in terms of CS scar niche and non-niche. In contrast to 34.4 % of the women who did not have uterine curettage, 56.3% of the women who had done uterine curettage had uterine scar niches. Conclusions: The CS scar niche could be reproducibly measured by a transvaginal scan in half of the cases with a visible CS scar at the first trimester of pregnancy, according to an ultrasonography evaluation. An increased chance of uterine niche formation in a subsequent pregnancy was linked to prior uterine curettage. The CS scar area may be connected to uterine scar dehiscence.

ЭКТОПИЧЕСКАЯ БЕРЕМЕННОСТЬ В РУБЦЕ НА МАТКЕ ПОСЛЕ КЕСАРЕВА СЕЧЕНИЯ

The localization of the ovum in the postoperative scar on the uterus is considered as a variant of ec-topic pregnancy with a high risk of maternal morbidity and mortality. A clinical case of diagnosis and treatment of a patient with ectopic pregnancy in the uterine scar after caesarean section, complicated by uterine bleeding, is described in the article. The clinical features and ultrasound diagnostic criteria are provided. Justification of the treatment tactics with hysterectomy is provided, taking into account the status of the patient, changes in the postoperative uterine scar, concomitant gynecological patholo-gy and willingness of the patient to accomplish the childbearing function.

Detection of Fat Cells in Uterine Scars During Normal Pregnancy and with Placenta Accreta Spectrum

The aim was to investigate the presence of fat cells (adipocytes) using morphological methods in the uterus of women without signs of scarring, with well–off scars after cesarean section (CS), as well as in a group of patients with different variants of atypical placentation.Material and methods. A retrospective histological and immunohistochemical study of the uterine wall material obtained during abdominal delivery in normal pregnancy without a previous CS in medical history (group 1, n=10), in normal pregnancy with a previous CS in anamnesis and the presence of a scar in the uterine wall (group 2, n=23) was performed, in pregnancy complicated by the ingrowth of placental villi (group 3, n=22).Results. In the uteroplacental region, the fat component was found in all three groups. No adipocytes were found in group 1 (0%). In group 2, fields of fat cells of different sizes were found in 19 cases out of 23 studied (83%) and only in the scar zone: in serosa 40%, in the perivascular zone 28%, among muscle bundles 15%. In the 3rd group with the ingrowth of placental villi into the scar zone, a “hernia” of the thinned uterine wall was detected in 68% of cases. The adipocytic component in this group was detected in 86% of cases (19 out of 22). Localization of adipocytes was observed in serosa (56%), in the perivascular zone (25%) and among muscle bundles (6%). No adipocytic component was found in the uterine wall outside the scar tissue.Conclusion. An adipocytic component was identified, undoubtedly associated with traumatic damage to the uterus and the presence of a scar in the wall. What are the relationships between the presence of fat cells in the scar tissue and its predisposition to the pathology of ingrowth of villi is unknown and requires further research.

Uterine microbiome in women with uterine scar defect after cesarean section: Prospective cohort study

Aim. To evaluate the endometrial microbiota in patients with uterine scar defect after cesarean section.&#x0D; Materials and methods. The study included 80 women of reproductive age. The main group included 50 patients with a uterus scar defect due to cesarean section; the comparison group included 30 women with a competent uterus scar due to cesarean section. Patients underwent a Pipelle endometrial biopsy on days 2022 of the menstrual cycle using a double-lumen catheter that excludes sample contamination with vaginal and cervical microflora. A molecular genetic study of the endometrium was performed by real-time polymerase chain reaction using the Femoflor 16 reagent kit (DNA-Technology&#x0D; Moscow). The DNA content in the specimen was measured using software and expressed in genome equivalent (GE) proportional to the number of microorganisms. The statistical data were processed using the Exсel software package and SPSS Statistics 22.0.&#x0D; Results. The study showed the following statistically significant differences: lower count of Lactobacillus spp. 2.600 (1.4303.600) GE/mL vs 3.550 (2.8004.700) GE/mL in patients of the comparison group (p=0.02); higher count of Streptococcus and Staphylococcus spp. 3.270 (3.0003.700) GE/mL and 3.450 (3.2003.600) GE/mL vs 1.030 (0.7601.700) GE/mL and 0.560 (0.1201.200) GE/mL in the comparison group, respectively (p0.00001); higher count of Enterobacteriaceae 2.700 (1.7003.300) GE/mL vs 0.950 (0.6601.120) GE/mL in the comparison group (p0.00001); higher count of Gardnerella/Prevotellabivia/Porphyromonas spp. 2.310 (0.9303.480) GE/mL vs 1.000 (0.0001.860) GE/mL (p=0.003); higher count of Peptostreptococcus spp. 0.195 (0.0001.560) GE/mL vs 0.000 (0.000-0.000) GE/mL (p=0.032); Eubacterium spp. 1.355 (0.1002.460) GE/mL vs 0.000 (0.0001.560) GE/mL (p=0.040).&#x0D; Conclusion. Endometrial dysbiosis in patients with a uterus scar defect after cesarean section due to the possible effects of microorganisms can be considered one of the leading causes of the formation of a uterus scar defect in the postoperative period.

Comparative morphological characteristics of the uteroplacental area in abnormal placentation

The aim. To carry out a comparative morphological characteristic of the uteroplacental area with abnormal placentation – pl. accreta, pl. increta, pl. percreta. Materials and methods. The study included 47 patients with atypical placentation; the comparison group included 10 healthy pregnant women with uterine scar after a previous caesarean section. A histological study of uteroplacental area samples was performed with hematoxylin and eosin, methylene blue staining. An immunohistochemical study with primary antibodies to cytokeratin 7 (CK7), Hif2a, vascular endothelial growth factor, α-SMA was carried out. The differences between the compared values were considered to be statistically significant at p &lt; 0.05. The results of the study. Pl. accreta was determined in 12 (25.5 %), pl. increta – in 30 (63.9 %), pl. percreta – in 5 (10.6 %) patients. In all patients of the main group, the decidua was completely or partially absent in the area of abnormal placentation or was replaced by an uneven layer of fetal fibrinoid. Cases when placental villi unevenly penetrated into the thickness of myometrium in the form of “tongues” or “coves” bordered by fetal fibrinoid and often located intermuscularly were defined as pl. increta (n = 26). Cases with the placental villi ingrowth to the serous membrane were considered as pl. percreta (n = 5). In cases with deep variants of ingrowth (pl. increta and pl. percreta) (n = 31), the villi were visualized in the lumen of the vessels and the thinning of the lower uterine segment with the presence of stretched muscle bundles was revealed. Aseptic necrosis of the myometrium was found: in 2 (16.7 %) of 12 women with pl. accreta, in 26 (86.7 %) of 30 women with pl. increta and in 5 (100 %) women with pl. percreta. There were no areas of necrosis in the myometrium of the women of comparison group. Conclusion. The appearance and increase of myometrial necrosis zones in response to an increase in the depth of placental villus ingrowth were detected. Myometrial necrosis zones could be the cause of activation of angiogenic factors and an important stimulus for the development of abnormal vascularization in placenta accreta spectrum.

OPTIMAL METHODS OF DELIVERY IN PREGNANT WOMEN WITH ONE UTERINE SCAR

The purpose of the study was development of optimal delivery tactics for women with a uterine scar. 103 pregnant women and the outcomes of their births were studied. Research and scientific work were carried out for 2020-2022. on the basis of the obstetric department of the multidisciplinary clinic of SamSMU. The optimal delivery tactics directly depend on the presence of somatic pathology, the timing of pregnancy, clinical signs of correction of thepostoperative scar, ultrasound data, the level of type XXVI collagen and rehabilitation measures after cesarean section.

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

IMPROVING THE DIAGNOSTICS OF UTERUS SCAR AFTER CESAREAN SECTION

Around the world, the number of caesarean sections is increasing every year. The purpose of the study was tostudy the consistency of the uterine scar after cesarean section in pregnant women of reproductive age; 103 pregnant women and the outcomes of their births were studied. Research and scientific work were carried out for 2020-2022. on the basis of the obstetric department of the multidisciplinary clinic of SamSMU. Based on clinical data, objective examination, ultrasound and Doppler measurements, as well as the amount of collagen type XXVI, in 66 pregnant women the condition of the postoperative scar was assessed as satisfactory and in 37 as insolvent