Uterine Scar Research Articles

Caesarean scar defect and retained products of conception (RPOC): a step-by-step combined hysteroscopic and laparoscopic treatment.

Uterine scar defect (also called uterine niche or isthmocele) associated to retained products of conception (RPOC) is an uncommon occurrence following caesarean section. Typically, the primary indicator is abnormal vaginal bleeding, and an accurate diagnosis can be established through ultrasound evaluation. Several surgical and endoscopic treatments have been described. To show a step-by-step video of combined hysteroscopic and laparoscopic approach to perform isthmocele repair in a patient with caesarean scar defect and RPOC. We report a case of a 34-year-old patient who was referred to our Digital Hysteroscopic Clinic (DHC) for abnormal vaginal bleeding and persistent pelvic pain, three months after a caesarean section. A single-step diagnostic approach through transvaginal ultrasound and diagnostic hysteroscopy revealed the presence of an isthmic uterine niche within the caesarean scar area, containing a poorly vascularised heterogeneous hyperechoic focal mass measuring 33x11x33 millimetres. Removal of RPOC and surgical complications. All retained placental tissue was removed and the uterine wall defect was corrected. No complications occurred and the patient was discharged two days after the procedure. Patient was asymptomatic at 3 months follow up and ultrasound and hysteroscopy showed a reconstituted uterine wall. An integrated hysteroscopic and laparoscopic approach seems to be an effective conservative method to remove RPOC and perform isthmocele repair with optimal surgical results.

Duration of Induction of Labor for Second-Trimester Medication Abortion and Adverse Outcomes.

To evaluate the relationship between duration of labor during second-trimester medication abortion and adverse outcomes. We conducted a retrospective cohort study including all individuals with a singleton gestation undergoing second-trimester medication abortion without evidence of advanced cervical dilation, rupture of membranes, or preterm labor at four centers. The primary exposure was duration of labor (ie, hours spent from receiving misoprostol to fetal expulsion). The primary outcome was composite morbidity , defined as uterine rupture, need for blood transfusion, clinical chorioamnionitis, intensive care unit admission, or need for readmission. We performed bivariate and multivariate negative binomial analyses. A post hoc subgroup analysis was performed to assess for the risk of the primary outcome by gestational age. We performed tests of homogeneity based on history of uterine scarring and parity. Six hundred eighty-one individuals were included. The median duration of labor was 11 hours (interquartile range 8-17 hours). One hundred thirty-one (19.2%) experienced the primary outcome. When duration of labor was evaluated continuously, a longer duration of labor was associated with an increased frequency of morbidity (adjusted β=0.68, 95% CI, 0.32-1.04). When duration of labor was evaluated categorically, those experiencing the highest quartile of duration (ie, 17 hours or more) had a statistically higher risk for experiencing morbidity compared with individuals in all other quartiles (adjusted relative risk 1.99, 95% CI, 1.34-2.96). When we focused on components of the composite outcome, clinical chorioamnionitis was significantly different between those experiencing a longer duration and those experiencing a shorter duration of labor (26.2% vs 10.6%, P <.001). On subgroup analysis, gestational age was not associated with the risk of composite morbidity. Tests of homogeneity demonstrated no significant difference in the risk for morbidity among individuals with a history of uterine scarring or based on parity. Duration of labor was independently associated with risks for adverse maternal outcomes during second-trimester medication abortion, specifically clinical chorioamnionitis.

RISK FACTORS OF LOW PLACENTATION

The purpose of the study – to assess the risk factors for the occurrence of low placentationin the early stages of gestation.Materials and methods. A clinical and statistical analysis of 150 individual charts ofpregnant women and women in labor in women with a low lying placenta (main group)and 80 pregnant women with a normal localization of the placenta in the fundus andbody of the uterus (control group), who were under dispensary supervision in a women’sconsultation, was carried ou.tThe results. After conducting the analysis, it was established that the main groupwas dominated by women over 30 years old (40.7 % of cases), compared to 25.0 %of pregnant women in the control group (p&lt;0.05). The age of onset of menarche after14 years is marked significantly more often in pregnant women with low placentation –in 22.7 %, compared to normal localization of the placenta – in 8.8 % of cases. Thedevelopment of the menstrual cycle by one year in the main group was 2.5 times lessfrequent than in the control group. 58.7 % of pregnant women with low placentationhad 2 or more artificial abortions, 46 % had a history of spontaneous miscarriages, inpregnant women with normal placentation, these indicators were 32.5 % and 18.8 % ofpregnant women, respectively (p&lt;0.05). In 20.7 % of cases of women in the main group,childbirth was completed by cesarean section, and in the control group – in 7.5 % ofcases. In pregnant women with low placentation, 26.0 % had inflammatory diseases ofthe uterine appendages, 50.7 % had cervical erosion, 10.7 % had uterine fibroids, 16.7 %had endometriosis, compared to the control group in 17 .5 %, 36.3 %, 3.8 % and in 6.3 %of cases, respectively (p&lt;0.05). Conservative myomectomy was performed in 30 % ofcases of the main group and 12.5 % of women in the control group. Conclusions. Risk factors for low placentation are a woman’s age over 30 years, latemenarche and late onset of menstrual function, history of gynecological diseases, highbirth parity, history of spontaneous miscarriages and artificial abortions, uterine scar,and manual revision of the uterine cavity walls. Identifying the risk factors for lowplacentation will reduce the level of perinatal and obstetric complications.

Facing the unimaginable: Case series of hysterotomy at a tertiary care centre

Hysterotomy is a surgical procedure involving a planned incision in the uterus. Although it is not commonly used for abortions, its incidence has increased due to higher rates of caesarean sections and placenta accreta spectrum.We report three such cases, first of a retained head of decapitated fetus; second of a patient with previous three caesarean section; and third of a patient with placenta previa. This surgical technique is rarely used for abortions, but if it has to be done it is associated with a high rate of morbidity. With the increase in the incidence of previous uterine scars, the rate of placenta accreta spectrum has increased. Hysterotomy may be required in these cases.

How the Mode of Delivery Is Influenced by Patient's Opinions and Risk-Informed Consent in Women with a History of Caesarean Section? Is Vaginal Delivery a Real Option after Caesarean Section?

Background/Objectives: In recent years, there has been a noticeable increase in the rates of caesarean section (CS), being one of the most commonly performed surgical procedures. For the following pregnancy, the previous CS represents the backbone of the risks and complications, such as uterine scar formation, uterine rupture, massive bleeding, and serious negative outcomes for both the mother and child. Our study followed patients with a history of CS from the birth planning prenatal check-up to delivery. Methods: We reviewed the records of 125 pregnant women with previous CS who presented in the third trimester for a prenatal check-up and completed our questionnaire from March 2021 to April 2022 in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. Results: Before the prenatal check-up, 74 patients (59.2%) preferred vaginal delivery (VD), while 51 (40.8%) preferred CS. After discussing birth planning with the obstetrician, 72 women (57.6%) decided upon VD, while 53 (42.4%) preferred CS. Ultimately, 78 (62.4%) of women gave birth through CS (either planned or by medical necessity) and 47 (37.6%) gave birth vaginally (either natural or per vacuum extraction). Conclusions: VD for patients with CS in their medical history is a real option. The patient must be well informed about the risks and benefits of the medical situation and should be empowered and supported on their chosen mode of delivery, which should be respected.

How to perform standardized sonographic examination of Cesarean scar pregnancy in the first trimester.

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications, such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of Maternal Infectious Morbidity of Two Methods of Fetal Delivery During Cesarean Section at Full Cervical Dilatation

Background: Caesarean section at full cervical dilatation is accompanied by higher risks of complications including the difficulties in delivering babies with deeply impacted heads. Different techniques are used to deal with this challenge. The two commonly used methods are push method and pull method. Objectives: To compare maternal infectious morbidity between reverse breech extraction and vaginal head push technique, for delivering baby, during second stage cesarean section. Materials and Methods: A total of 170 women with caesarean section at full cervical dilatation due to failure to progress, singleton alive fetus, cephalic presentation took part in this observational study conducted, from 1st February 2019 to 31st January 2022 at OBGYN Department LRH, MTI Peshawar. Women with multiple pregnancies, fetal distress, fetal anomalies, previous uterine scar, chorioamniotis, fever were excluded. In Group I women, head push technique and, in group II women, pull method was performed. All women were followed till first week of birth for pyrexia, wound infections and blood transfusion.Results: Maternal pyrexia developed in 13 (15.29%) patients in the pull method/Group II women, and 25 (29.41%) in the push approach group (p = 0.047). Infection of caesarean wound occurred in 04 (4.71%) in Group II, and 12 (14.12%) of Group I women (p = 0.065). Blood transfusion was needed in 25(29.41%) of Group II and, in 19(22.35%) cases of Group I (p=0.381).Conclusion: This study concluded that maternal outcome in terms of infectious morbidity is better after breech extraction in caesarean section during second stage of labour.Keywords: Head push, pyrexia, Reverse breech extraction, Wound infection.

Ultrasound Screening of Placenta Accreta Spectrum in Early Pregnancy

Placenta accreta spectrum (PAS) is associated with serious complications. Early recognition may lead to enhanced care, counseling and more favorable pregnancy outcomes. To evaluate the role of first trimester ultrasound in early prediction of PAS and subsequent management. This is a case-control study of 60 pregnant women with uterine scars and early pregnancy sonographic signs of placenta accreta, who were delivered at Beni-Suef University Hospital. Based on the presence of morbidly adherent placenta (MAP) at the time of delivery, subjects were divided into two groups. Sonographic findings and outcomes were compared in both groups. At Caesarean section, 32/60 patients (53.3%) had evidence of MAP. Older age, higher parity and number of previous sections were significantly associated both with the presence of MAP and with the requirement for Caesarean-Hysterectomy. During first trimester scan, bridging vessels and low gestational sac were the most common findings (n=35 &amp; 34 respectively). All sonographic findings were significantly associated with the presence of MAP. Using weighted OR model, thin myometrium and lacunae had significant independent associations with MAP (p=0.02 &amp; 0.008 respectively). Regarding third trimester scans, sonographic evidence of placenta accreta was present in all patients with MAP at C.S. and only 29% in those without (100% sensitivity, 71% specificity; p=0.001). Post-partum hemorrhage and transfusion requirement were present in 36 cases (60%), including 94% oi cases of MAP (p=0.001). Pelvic devascularization, hysterectomy and ICU admission only occurred in those with MAP. Early sonographic assessment of pregnancies with previous cesarean delivery or uterine surgery can predict the presence of MAP disorder and improve the surgical outcome.

Barbed vs conventional sutures for cesarean uterine scar defects: a randomized clinical trial

BackgroundThe role of barbed sutures in preventing myometrial defects and enhancing postpartum outcomes after cesarean section (C-section) is uncertain. ObjectiveThis study compared clinical and ultrasonographic outcomes of uterine scar defects after C-section with barbed and conventional smooth thread sutures. Study DesignThis was a multicenter, parallel-group, randomized, controlled clinical trial. Four obstetrics and gynecology departments across three Japanese healthcare regions were included. The participants were women requiring their first cesarean delivery between May 2020 and March 2023. Of the 1211 participants enrolled, 298 underwent C-section and 253 were followed up until July 2023. Participants with singleton pregnancies were randomly assigned (1:1 ratio) to receive either conventional or spiral thread sutures with a double-layer continuous suture. The study period comprised the time of consent to the 6- to 7-month examination. The primary endpoint was the rate of scar niches >2 mm evaluated using transvaginal ultrasonography at 6 to 7 months after surgery. Additional metrics included the total operative time, suture application time, operative blood loss, number of additional sutures required for hemostasis, maternal surgical complications, postoperative infections, surgeon's years of experience, and individual subscale scores. ResultsAll data of the 220 participants (barbed suture group: 110; conventional suture group: 110) were available, thus enabling a full analysis set. A comparison of the barbed and conventional suture groups, respectively, revealed the following: niche length, 2.45±1.65 mm (range: 1.0–6.7) vs 3.79±1.84 mm (range: 1.0–11.0) (P<.001); niche depth, 1.78±1.07 mm (range: 1.0–5.7) vs 2.70±1.34 mm (range: 1.0–7.3) (P<.001); residual myometrial thickness (RMT), 8.46±1.74 mm (range: 4.8–13.0) vs 7.07±2.186 mm (range: 2.2–16.2) (P<.001); and niche width, 1.58±2.73 mm (range: 0.0–14.0) vs 2.88±2.36 mm (range: 0.0–11.0) (P<.001), respectively. The barbed suture group exhibited no defects and an RMT <3 mm. Furthermore, the barbed suture group had a lower rate of uterine niches (29.1%; n=32/110) than the conventional suture group (68.2%; n=75/110). Secondary outcomes showed no significant differences in operative times, maternal surgical complications, or postoperative complications. ConclusionDouble-layer barbed sutures during cesarean delivery may prevent C-section scar defects and postoperative complications.El resumen está disponible en Español al final del artículo.

Assessment of Uterine Scar and its Possible Defect after Cesarean Section by Transvaginal Ultrasound

Assessment of Uterine Scar and its Possible Defect after Cesarean Section by Transvaginal Ultrasound

Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study

BackgroundThe rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean can be as high as 27-32.7%. Induction of labor after one previous cesarean (IOLAC) is a high-risk procedure mainly due to the higher risk of uterine rupture. Nevertheless, the American College of Obstetricians and Gynecologists considers IOLAC as an option in motivated and informed women in the appropriate care setting. We sought to identify predictors of a composite of maternal and newborn adverse outcomes following IOLAC.MethodsThe electronic medical records of women who delivered between January 2018 to September 2022 in a Malaysian university hospital were screened to identify cases of IOLAC. A case is classified as a composite adverse outcome if at least one of these 11 adverse outcomes of delivery blood loss ≥ 1000 ml, uterine scar complications, cord prolapse or presentation, placenta abruption, maternal fever (≥ 38 0C), chorioamnionitis, intensive care unit (ICU) admission, Apgar score < 7 at 5 min, umbilical artery cord artery blood pH < 7.1 or base excess ≤-12 mmol/l, and neonatal ICU admission was present. An unplanned cesarean delivery was not considered an adverse outcome as the practical management alternative for a clinically indicated IOLAC was a planned cesarean. Bivariate analysis of participants’ characteristics was performed to identify predictors of their association with composite adverse outcome. Characteristics with crude p < 0.10 on bivariate analysis were incorporated into a multivariable binary logistic regression analysis model.ResultsElectronic medical records of 19,064 women were screened. 819 IOLAC cases and 98 cases with composite adverse outcomes were identified. Maternal height, ethnicity, previous vaginal delivery, indication of previous cesarean, indication for IOLAC, and method of IOLAC had p < 0.10 on bivariate analysis and were incorporated into a multivariable binary logistic regression analysis. After adjustment, only maternal height and IOLAC by vaginal dinoprostone compared to Foley balloon remained significant at p < 0.05. Post hoc adjusted analysis that included all unplanned cesarean as an added qualifier for composite adverse outcome showed higher body mass index, short stature (< 157 cm), not of Chinese ethnicity, no prior vaginal delivery, prior cesarean indicated by labor dystocia, and less favorable Bishop score (< 6) were independent predictors of the expanded composite adverse outcome.ConclusionShorter women and IOLAC by vaginal dinoprostone compared to Foley balloon were independently predictive of composite of adverse outcome.

Minimally Invasive Techniques in Myomectomy and Fertility Outcomes: A Narrative Review of the Current Evidence

Objective: This narrative review aims to summarize the current evidence regarding fertility outcomes associated with different minimally invasive surgery (MIS) techniques in myomectomy. Mechanism: Uterine leiomyomas, commonly known as fibroids, are benign tumors affecting women of reproductive age. Surgery, particularly minimally invasive techniques, represents a definitive treatment for symptomatic fibroids, with preservation of fertility being a key consideration. MIS myomectomies, including laparoscopic, robotic-assisted laparoscopic myomectomy (RALM), and mini-laparotomy, are preferred over open laparotomy due to reduced morbidity and quicker recovery times. However, these procedures still carry risks, including uterine scar dehiscence and subsequent effects on pregnancy outcomes. Findings in Brief: Studies reviewed generally indicate favorable pregnancy outcomes across different MIS techniques, although with varying success rates. Conventional laparoscopy and RALM show promising pregnancy rates, akin to those observed with laparotomy. Nonetheless, higher numbers of fibroids removed during RALM correlate with increased rates of preterm births. The literature comparing laparotomy to laparoscopy, as well as across various MIS techniques, presents inconsistent results, likely due to the complexity and heterogeneity of fibroids, which can significantly impact fertility outcomes. Conclusions: Overall, myomectomy, irrespective of the approach employed, is generally associated with favorable fertility outcomes. While there are variations in success rates among different MIS techniques, no significant differences in the mode of delivery or the incidence of complications such as uterine rupture and adhesion formation are noted. Clinicians should consider individual patient factors when selecting the most appropriate technique for myomectomy. Ongoing advancements in surgical technology are likely to impact the landscape of MIS myomectomy and its implications for fertility outcomes. Further research and meta-analyses are warranted to clarify differences between MIS techniques and optimize patient outcomes.

Evaluation of the Effects of Epidural Labour Analgesia on Mode of Delivery in 250 Bedded District Hospital, Bagerhat, Bangladesh

Background: Labor pain is intensely severe, often leading to hyperventilation and hormonal releases that can harm the fetus by reducing oxygen supply and causing metabolic acidosis. Effective pain management during childbirth is crucial for both physical and mental health. Various pharmacologic and non-pharmacologic methods are available, with epidural analgesia being a prominent choice. It is widely used in high-income countries, provides substantial pain relief, and benefits uterine contractions and placental perfusion. Epidural analgesia has potential side effects and controversies, such as delayed labor and higher intervention rates. Aim of the Study: The study aimed to examine the impact of epidural analgesia on the mode of delivery. Methods: This observational study, conducted from July 2021 to June 2022 at the Department of Gynecology and Obstetrics in a 250-bed District Hospital in Bagerhat, Bangladesh, included 50 participants divided into two groups of 25 each: Group A (with epidural analgesia) and Group B (without epidural analgesia). Approved by the Ethical Committee, the study included women aged 18-35 years, 37-41 weeks gestation, in labor with regular contractions, at least 4 cm cervical dilatation, and a regular fetal heart rate pattern. Excluded were women with medical or obstetrical complications, uterine scars, or spinal deformities. Data were collected via interviews, observations, and clinical examinations. Result: In this study of 50 participants (25 per group), most women were under 30 years old, with mean ages of 22.4±4.5 and 22.9±5.2 years in groups A and B, respectively. Gestational ages ranged from 37 to 40 weeks, and BMIs were 18.5-24.9 kg/m². Both groups had similar parity distributions. Normal vaginal births occurred in 84% (Group A) and 88% (Group B), with LSCS rates at 4%. Group A had 60% male neonates with average birth weights of 2.86±0.27 kg, and Group B had 56% males with weights of 2.88±0.26 kg. APGAR scores were high in both groups. Conclusion: Epidural labor analgesia is safe and does not increase instrumental deliveries or affect neonatal outcomes, making it a viable pain management option. Obstetric care providers can use this information to counsel women.

Isthmocele: controversial issues of terminology, diagnosis and treatment. A review

The frequency of abdominal delivery in the world is steadily rising. Since the latter is associated with a lot of complications compared with vaginal delivery, the increase in the proportion of deliveries in women with a uterine scar through the natural birth canal is an important strategic goal of the obstetrics and gynecology community. In addition, it is established that every second patient after a cesarean section develops a defect in the scar area, which is often accompanied by various disorders of the menstrual cycle (in 25,5% of cases – abnormal uterine bleeding) and can cause secondary infertility. Both assessment of the risk of scar failure at the stage of preconceptional preparation and timely detection and treatment of isthmocele symptoms are still serious challenges facing obstetricians and gynecologists. Clinical guidelines devoted to the cesarean scar defect problem have not yet been developed. This review presents the quintessence of modern data on possible risk factors, clinical manifestations with a detailed consideration of pathophysiological mechanisms, diagnostic tools and correction methods of symptomatic isthmocele and uterine scar defect with a detailed description of indications and a comparative assessment of their effectiveness in order to standardize approaches to the diagnosis and treatment of these pathological conditions.

Appearance of Dehiscence at the Uterine Scar Site on Ultrasound: A Case Report

Appearance of Dehiscence at the Uterine Scar Site on Ultrasound: A Case Report

An unusual case of Uterine window revealing the placenta: A Diagnostic dilemma between Scar dehiscence and the Placenta Accreta Spectrum.

Uterine scar dehiscence, or the "uterine window," is a complication of a repeat cesarean section. Preterm delivery, caesarean sections performed more than twice in the past, or less than a 24-month interval between deliveries are all connected with an increased risk. The terms Placenta Accreta Spectrum (PAS) and uterine scar dehiscence are frequently used interchangeably. A 25-year-old unbooked pregnant woman, gravida 3 para 2 live 1, presented to OPD at 37 weeks gestation. During the intraoperative phase, we discovered a silent scar dehiscence with partially visible placental lobes under the intact serosa mimicking the Placenta Accreta Spectrum. A lower-segment caesarean section was performed, and the placenta was totally separated. After the cesarean incision was closed, the myometrial defect was corrected. It is crucial to distinguish it from disorders in the Placenta Accreta Spectrum, as prenatal imaging can be deceptive if not performed with the requisite expertise to distinguish between the two conditions. This distinction will inform the treatment strategies for uterine dehiscence and PAS disorders, which are distinct.

Surgical treatment and reproductive outcomes in caesarean scar pregnancy at a single center

BackgroundTo investigate factors associated with different reproductive outcomes in patients with Caesarean scar pregnancies (CSPs).MethodsBetween May 2017 and July 2022, 549 patients underwent ultrasound-guided uterine aspiration and laparoscopic scar repair at the Gynaecology Department of Hubei Maternal and Child Health Hospital. Ultrasound-guided uterine aspiration was performed in patients with type I and II CSPs, and laparoscopic scar repair was performed in patients with type III CSP. The reproductive outcomes of 100 patients with fertility needs were followed up and compared between the groups.ResultsOf 100 patients, 43% had live births (43/100), 19% had abortions (19/100), 38% had secondary infertility (38/100), 15% had recurrent CSPs (RCSPs) (15/100). The reproductive outcomes of patients with CSPs after surgical treatment were not correlated with age, body mass index, time of gestation, yields, abortions, Caesarean sections, length of hospital stay, weeks of menopause during treatment, maximum diameter of the gestational sac, thickness of the remaining muscle layer of the uterine scar, type of CSP, surgical method, uterine artery embolisation during treatment, major bleeding, or presence of uterine adhesions after surgery. Abortion after treatment was the only risk factor affecting RCSPs (odds ratio 11.25, 95% confidence interval, 3.302–38.325; P < 0.01) and it had a certain predictive value for RCSP occurrence (area under the curve, 0.741).ConclusionsThe recurrence probability of CSPs was low, and women with childbearing intentions after CSPs should be encouraged to become pregnant again. Abortion after CSP is a risk factor for RCSP. No significant difference in reproductive outcomes was observed between the patients who underwent ultrasound-guided uterine aspiration and those who underwent laparoscopic scar repair for CSP.

Human Umbilical Cord Mesenchymal Stem Cells Promote Anti-Inflammation and Angiogenesis by Targeting Macrophages in a Rat Uterine Scar Model.

Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) have demonstrated efficacy in repairing uterine scars, although the underlying mechanisms remain unclear. Uterine injury was surgically induced in a rat model, followed by immediate transplantation of 5 × 10 ^ 5 hUC-MSCs to each side of the uterus. Uterine morphology was evaluated at days 14 and 30 using HE and Masson staining. Immunohistochemistry assessed macrophage polarization, angiogenesis and endometrial receptivity in the endometrium. Additionally, the regulatory effects of hUC-MSCs on macrophage polarization were explored through coculture. qRT-PCR quantified the expression of anti-inflammatory (IL10 and Arg1) and pro-inflammatory (iNOS and TNF-α) factors. Western blotting evaluated CD163 expression. Transplantation of hUC-MSCs promoted the healing of uterine injuries and tissue regeneration while inhibiting tissue fibrosis. Immunohistochemistry at days 14 and 30 post-transplantation demonstrated the polarization of macrophages toward the M2 phenotype in the uterine injury area in the presence of hUC-MSCs. Furthermore, hUC-MSC transplantation improved angiogenesis and endometrial receptivity in the uterine injury rat model, associated with increased IL10 expression. hUC-MSC-induced angiogenesis can be resisted by depleted macrophages. In vitro coculture experiments further demonstrated that hUC-MSCs promoted IL10 expression in macrophages while suppressing TNF-α and iNOS expression. Western blotting showed enhanced CD163 expression in macrophages following hUC-MSC treatment. hUC-MSCs contribute to the healing of uterine injuries by targeting macrophages to promote angiogenesis and the expression of anti-inflammatory factors.

Effect of Single layer versus Double Layer Suturing on Healing of cesarean Uterine Scar: A Randomized controlled trial

Effect of Single layer versus Double Layer Suturing on Healing of cesarean Uterine Scar: A Randomized controlled trial

Courses of pregnancy in women witha uterine scar after conservative myomectomy

Introduction. Uterine fibroids are the most common disease of the female reproductive system. If indicated, the main organpreserving method of treatment is myomectomy. However, according to many researchers, women who have undergone conservative myomectomy are at a higher risk of developing complications during pregnancy such as placenta previa, placental disorders, and uterine scar failure.Aim. To identify the features of the course of pregnancy, childbirth and perinatal outcome in women with a uterine scar after conservative myomectomy who received pregravid preparation.Materials and methods. A retrospective study included an analysis of 159 outpatient histories of women planning pregnancy after conservative myomectomy, including the birth histories of 109 pregnant women aged 29–40 years who delivered at the Perinatal Center of the Regional Clinical Hospital in Khanty-Mansiysk from 2011 to 2021 in order to study the characteristics of the course of pregnancy in women with a scar on the uterus after conservative myomectomy.Results. When analyzing the data, the following statistically significant differences between the groups were revealed: the first trimester of pregnancy in women with a uterine scar compared with the control group was more often complicated by chorion presentation, threatened miscarriage, urinary tract infection and early toxicosis (p &lt; 0.05); in the second trimester of pregnancy in group 1, there were more often threatening preterm labor and placental disorders (p &lt; 0.05), the majority of women with a scar on the uterus after myomectomy (77.8%) were delivered by caesarean section, in contrast to the control group (9.7%) (p &lt; 0.05).Conclusion. The data we obtained on the course of pregnancy, childbirth and perinatal outcomes after myomectomy reflected the need and effectiveness of preconception preparation in this contingent of women.