Uterine Wound Research Articles

Mesenchymal stem cells and their conditioned medium can enhance the repair of uterine defects in a rat model

BackgroundOur aim was to examine the roles of mesenchymal stem cell (MSC) transplantation in the repair of large uterine defects. MethodsUterine defects were created in both uterine horns of female rats by a punch instrument, and bone marrow-derived MSCs, MSC-conditioned medium (MSC-CM) or vehicle were injected into the myometrium around the defect. The rate of uterine defect repair was monitored on day 2 and 4 after operation. Cytokine array of MSC-CM was performed, followed by neutralizing antibody experiments to clarify the exact cytokine participating in the MSC-CM-enhanced wound repair. ResultsTransplantation of MSCs, but not myometrial cells, significantly enhanced uterine defect repair. The transplanted MSCs were detected in the uterine horn with no signs of rejection on day 4 after transplantation, when the MSC-transplanted uterine wound was nearly healed. Moreover, uterine defect repair was also accelerated by injection of MSC-CM, indicating the paracrine effects of MSCs on uterine wound healing. Cytokine array analysis further revealed that MSC-CM contained abundant cytokines and chemokines, among which high levels of interleukin-6 (IL-6) were found. Additionally, antibodies against IL-6 were shown to block MSC-CM-enhanced uterine defect repair. ConclusionThis study demonstrated that transplantation of MSCs could enhance uterine defect repair by paracrine effects involving IL-6, which are findings that may be applied to facilitate uterine wound healing in the removal of huge intramural masses.

Uterine Wound Healing: A Complex Process Mediated by Proteins and Peptides.

Wound healing is the process by which a complex cascade of biochemical events is responsible of the repair the damage. In vivo, studies in humans and mice suggest that healing and post-healing heterogeneous behavior of the surgically wounded myometrium is both phenotype and genotype dependent. Uterine wound healing process involves many cells: endothelial cells, neutrophils, monocytes/macrophages, lymphocytes, fibroblasts, myometrial cells as well a stem cell population found in the myometrium, myoSP (side population of myometrial cells). Transforming growth factor beta (TGF-β) isoforms, connective tissue growth factor (CTGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and tumor necrosis factor alpha (TNF-β) are involved in the wound healing mechanisms. The increased TGF- β1/β3 ratio reduces scarring and fibrosis. The CTGF altered expression may be a factor involved in the abnormal scars formation of low uterine segment after cesarean section and of the formation of uterine dehiscence. The lack of bFGF is involved in the reduction of collagen deposition in the wound site and thicker scabs. The altered expression of TNF-β, VEGF, and PDGF in human myometrial smooth muscle cells in case of uterine dehiscence, it is implicated in the uterine healing process. The over-and under-expressions of growth factors genes involved in uterine scarring process could represent patient's specific features, increasing the risk of cesarean scar complications.

Laparoscopic Management of Heterotopic Istmocornual Pregnancy: A Different Technique

Study ObjectiveTo present a modified technique for laparoscopic cornual resection for the surgical treatment of heterotopic istmocornual pregnancy. DesignA step-by-step explanation of the surgery using video (Canadian Task Force Classification III-c). SettingHeterotopic pregnancy is the coexistence of pregnancy in both the intrauterine and extrauterine sides. The incidence is 1 in 30 000 in spontaneous pregnancies; however, the incidence increased to 1 in 100 to 1 in 500 pregnancies with the increasing number of artificial reproductive technologies [1,2]. Although management is controversial, there are 2 main approaches classified as surgical and nonsurgical. The administration of potassium chloride, methotrexate, and/or hyperosmolar glucose is a nonsurgical intervention; however, there are some limitations such as systemic side effects and the possible adverse effect on a live fetus [1–3]. For this reason, surgical intervention involving cornual resection is the main treatment option. Case ReportA 32-year-old patient was admitted to our clinic with sudden-onset pain at the left groin. She was at the 11th week of gestation. She had a diagnosis of infertility for 7 years, and she became pregnant after an in vitro fertilization cycle. At sonographic examination, 2 gestational sacs were detected, 1 with a live fetus settled into the uterus and the second (20-mm length) on the left cornual side without a yolk sac and embryo and the left adnexa accompanied with coagulated blood. Immediate laparoscopic surgery was planned. At the laparoscopic exploration, left istmocornual pregnancy that was ruptured and bleeding were observed. We performed a modified technique for laparoscopic cornual resection in which the uterine corn was tightened with the noose twice, and the corn was sutured circularly to avoid excessive bleeding. Initially, the mesosalpinx was coagulated and transected with bipolar energy. Afterward, the uterine corn was tightened with the noose twice, and the fallopian tube was removed. To reduce the bleeding during remnant cornual tissue extraction, a permanent 0 monofilament suture was passed deep into the myometrium and tightened to achieve better hemostasis. Then, the remnant cornual tissue was extracted with harmonic scissors, and the uterine wound was repaired with continuous suture to reduce the risk of uterine rupture during the ongoing pregnancy. Depot progesterone was administered just before the surgery and the day after. She was discharged on the first postoperative day. At the follow-up, she did not experience any problems during pregnancy, and she was delivered with cesarean section at 39 weeks’ gestation. ConclusionIn conclusion, laparoscopic surgery is a safe and feasible option for the treatment of heterotopic pregnancy, and control of bleeding can be achieved better with our modified technique.

Negative pressure wound treatment for uterine incision necrosis following a cesarean section

Abstract Extended-spectrum β-lactamase sepsis with concurrent uterine incision dehiscence after cesarean section with T-shaped incision for chorioamnionitis occurred in a 29-year-old patient after her first delivery. Following an exploratory laparotomy with a diagnosis of necrosis of the anterior uterine wall, a uterine negative-pressure wound treatment (NPWT) was performed, successfully avoiding hysterectomy and enabling secondary suture of the uterine wall.

Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation.

To evaluate whether use of the Fetal Pillow (Safe Obstetric Systems, Shenfield, UK) affects maternal and fetal morbidity in cesarean delivery at full cervical dilatation. A randomized controlled trial was conducted at two teaching hospitals in West Bengal, India, between April 1, 2013, and March 31, 2014. Women undergoing cesarean delivery at full dilatation were enrolled and randomly assigned with computer-generated random numbers (block size 10) to undergo delivery with or without the Fetal Pillow. Group assignment was not masked. The primary outcome was the incidence of major uterine wound extensions (grade 2-3). Overall, 120 women were assigned to each group. Major uterine wound extensions occurred in 6 (5.0%) women in the Fetal Pillow group and 39 (32.5%) in the control group (relative risk 0.23, 95% confidence interval 0.11-0.48). Use of the Fetal Pillow in second-stage cesarean delivery significantly reduces the risk of a major extension of the uterine incision. CTRI registration number: CTRI/2015/03/005651.

Post-caesarean Haematomas, Septic Collections and Wound Disruptions- Re-Laparotomy Based on Abdominal Imaging.

Raising incidence of caesarean section is a global concern, especially in the low resource countries [1,2]. Inadequate aseptic precautions, improper surgical technique, indiscriminate use of antibiotics leading to increasing antibiotic resistance, suboptimal post-operative care and ascending genital infections all contribute to increasing incidence of post-caesarean abdominal sepsis. We present a series of six referrals in 12 months; who presented with post-caesarean haematomas, septic collections and uterine wound dehiscence. Decision for re-laparotomy had to be taken diligently taking clinical picture along with imaging findings.

Pelvic Abscess with Uterine Wound Dehiscence Post Cesarean Section, Rare Presentation with Modified Management: Case Report & Literature Review

The rate of caesarean section rate is increasing worldwide, the ideal rate being from 10 to 15% according to WHO. Various complications are associated with this operative procedure, such as intraoperative hemorrhage, wound and chest infections, abdominal wound dehiscence, from anesthesia, deep vein thrombosis, and pulmonary embolism to name a few. Uterine wound dehiscence is a very rare complication of cesarean section that presents with PPH[1]. Postoperative pyrexia may result from various causes, pelvic abscess being a very rare one, occurring in < 1% of patients with post cesarean endometritis[2]. This report describes anunusual cause of fever following cesarean delivery and presentation of its sequelae, our method of management, its outcome with comparison to similar cases presented in the literature. This the first case report in literature of post-operative pelvic abscess with uterine wound dehiscence, a rare presentationthat was managed with radiological intervention and assistance.

609: Uterine wound healing of sheep hysterotomy in pregnancy

609: Uterine wound healing of sheep hysterotomy in pregnancy

Manejo de la gestante con una cesárea previa.

Se realizó un estudio retrospectivo de 1045 pacientes gestantes que tuvieron una cesárea previa y fueron atendidas entre el l2 de enero y el 3l de diciembre de 1992, en el Instituto Materno Perinatal. Se dividió a las pacientes en dos grupos, según que lograron un patio vaginal o fueron sometidas a cesárea de repetición. Se obtuvo una tasa de parto vaginal de 80% entre 561 pacientes a quienes se les permitió una prueba de trabajo de parto. Se realizó parto instrumentado en dos pacientes. Se reintervino por indicación obstétrica absoluta a 475 pacientes (76,70%) y por criterio del examinador a 121 pacientes (20,30%). La principal indicación de cesárea para las pacientes que fallaron la prueba de trabajo de parto fue un sufrimiento fetal (44%). Se encontró dehiscencia de cicatriz uterina en 1,53%. Las complicaciones placentarias fueron acretismo placentario y placenta previa en 0,29% y 1,44%, respectivamente. No hubo muertes maternas. La morbilidad puerperal y los días de hospitalización fueron significativamente mayores en pacientes a quienes se les sometió a nueva cesárea. La morbimortalidad del recién nacido fue similar en los dos grupos de pacientes.

Randomized Controlled Trial on the Effect of Channa striatus Extract on Measurement of the Uterus, Pulsatility Index, Resistive Index of Uterine Artery and Superficial Skin Wound Artery in Post Lower Segment Caesarean Section Women.

AimTo compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo.Background Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain.MethodologyThis study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively.ResultsSixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively).ConclusionDaily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS.Trial Registration www.isrctn.com 11960786

Role of galectins in re-epithelialization of wounds.

Re-epithelialization is a critical contributing process in wound healing in the human body. When this process is compromised, impaired or delayed, serious disorders of wound healing may result that are painful, difficult to treat, and affect a variety of human tissues. Recent studies have demonstrated that members of the galectin class of β-galactoside-binding proteins modulate re-epithelialization of wounds by novel carbohydrate-based recognition systems. Galectins constitute a family of widely distributed carbohydrate-binding proteins with the affinity for the β-galactoside-containing glycans found on many cell surface and extracellular matrix (ECM) glycoproteins. There are 15 members of the mammalian galectin family that so far have been identified. Studies of the role of galectins in wound healing have revealed that galectin-3 promotes re-epithelialization of corneal, intestinal and skin wounds; galectin-7 promotes re-epithelialization of corneal, skin, kidney and uterine wounds; and galectins-2 and -4 promote re-epithelialization of intestinal wounds. Promising prospects for developing novel therapeutic strategies for the treatment of problematic, slow- or non-healing wounds are implicit in the findings that galectins stimulate the re-epithelialization of wounds of the cornea, skin, intestinal tract and kidney. Molecular mechanisms by which galectins modulate the process of wound healing are beginning to emerge and are described in this review.

Routine cervical dilatation during elective caesarean section. Should we continue?

The caesarean section rate is on the increase globally, with its attendant complications. One of the measures adopted by obstetricians to decrease complications, such as endometritis and blood loss is intraoperative cervical dilatation during elective caesarean section. A multicentre double blind randomised controlled trial was carried out in Enugu, Nigeria, to ascertain the usefulness of this practice. A total of 208 pregnant women were randomised: 104 had intraoperative cervical dilatation and the other 104 did not have their cervices dilated. All the patients had similar preoperative, intraoperative and postoperative care and were followed up to 6 weeks postpartum. There was no significant difference between the two groups. In conclusion, the study shows no benefit in routine intraoperative cervical dilation. Practitioners must make sure that neither the placenta nor fetal membrane is overlying the internal os before they close the uterine wound.

English

Generalized peritonitis following lower segment caesarean section with uterine incision necrosis and dehiscence presenting as genitourinary fistula is very unusual. Herein we report a case of 28 years old woman who was received in emergency hours as a referred case from a private nursing home with history of caesarean section done 11 days back for premature rupture of membranes and pregnancy induced hypertension. She came with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 4-5 days. Here acute abdomen series was done. The urologist ruled out genitourinary fistula. CECT of abdomen was done. She was diagnosed to be a case of generalized peritonitis following caesarean section with necrosis and dehiscence of suture line of uterus through which ascitic fluid was being drained into vagina. Consequently, patient underwent laparotomy. Gentle adhesiolysis with supra cervical hysterectomy was done. Thorough drainage and irrigation of pelvi-abdominal cavity was done. Post-operative period was uneventful. INTRODUCTION: It is unusual for peritonitis to develop following caesarean delivery. It is almost invariably preceded by metritis and uterine incisional necrosis and dehiscence. Other cases may be due to inadvertent bowel injury at caesarean delivery. Yet another cause is peritonitis following rupture of a parametrial or adnexal abscess.1 Herein we report a case of 28 years old woman who was received in emergency hours as a case of post-operative caesarean section which was done in a private nursing home 11 days back. She presented with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 6-7 days. The first clinical impression that she gave was that of a genitourinary fistula following caesarean section. After complete work up, her provisional diagnosis was to be a case of generalized peritonitis following post caesarean uterine wound necrosis with dehiscence and the ascitic fluid was being drained through this uterine rent. Emergency laparotomy was done. Gentle adhesiolysis with supracervical hysterectomy was done. Post-operative period was uneventful.

Vacuum retraction of uterus for the management of atonic postpartum hemorrhage

Background: Creating negative pressure inside the uterine cavity results in shrinking of uterus which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhage. Methods: Sixteen women who had normal vaginal delivers, and 4 women who underwent caesarean sections, who developed atonic postpartum hemorrhage, and who did not respond well for routine use of Inj. methergine, oxytocin, and Carboprost were included in this study. A specially designed uterine cannula measuring 25cm long and with 12/18mm diameter, with uterine angle, and with multiple perforations on uterine portion was used. When bleeding did not stop due to uterine atony in vaginal deliveries in spite of routine measures, the uterine portion of the cannula was inserted in to uterine cavity up to fundus, and the outer end was connected to suction machine with thick walled flexible tubing. A negative pressure of 650mmHg was created inside the uterine cavity and maintained for 10mns. This procedure wasrepeated every hour for 3hrs. After this the negative pressure was created whenever there was recurrence of bleeding. In case of caesarean section, the cannula was inserted through the uterine wound and brought outside through vagina. Negative pressure was applied after closure of uterine wound. The cannula was removed in all women6hrs after initiation of procedure. Results: complete cessation of bleeding which was associated with contraction and firm retraction of uterus was observed in all women within 4mns after initiation of procedure. The amount of blood collected in suction bottle ranged from 150ml to 250ml. Conclusion: Vacuum shrinking of uterus is a very effective physical method which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhage. This simple, cost effective, life-saving, and fertility saving technique, which can avoid laparotomy can be made available in any setting, and can become the first defense against atonic PPH.

Features of uterine scar after cesarean section depending on the time of delivery

The article includes the results of comparative study of uterine scar after cesarean section depending on the time of surgery – at term pregnancy or during the term labor. There was more intense neoangiogenesis in the uterine wound at early postoperative period and the number of patients with morphologically “sufficient” uterine scar increased in 2 times when cesarean section was performed at term labor.

English

OBJECTIVES: Evaluation of a new surgical technique to prevent postpartum haemorrhage during cesarean section for major degree placenta previa - A comparative analysis. METHODS: This study was conducted at tertiary care hospital (JNM, NSGH, CN) at Kalyani Nadia, West Bengal, India from the period January 2006 to December 2011. Sixty (60) cases diagnosed to be having major degree placenta previa, undergoing LSCS operation, were selected for this study in two groups for comparative analysis. Group A(N-30) - New surgical technique(Dutta 's) institute in a stepwise manner = delivery of baby > bilateral uterine artery ligation by chromic catgut no-1 suture >injection tranexamic acid (1000mg) IM > injection oxytocin in intravenous infusion (10 units 30 drop /min in 500 ml of 5% dextrose)>delivery of placenta and membranes> checked properly if any tear or laceration in placental site > closure of uterine wound by chromic catgut no 1 in two layers after securing bleeding from placental bed >closure of abdomen in layers . Group B (N-30) (traditional method) = delivery of baby> delivery of placenta and its membrane > injection oxytocin in intravenous infusion (10 units 30 drop /min in 500 ml of 5% dextrose ) > surgical intervention either by bilateral uterine artery or internal iliac artery ligation or cesarean hysterectomy or underlying interrupted suture to control post operative haemorrhage > closure of uterine wound by chromic catgut no 1 suture in two layers > closure of abdomen in layers. RESULTS: It was observed from this comparative analysis that in group B intra operative blood loss > 500cc -18 (60%), cesarean hysterectomy- 6(20%) and bilateral internal iliac artery ligation- 4 (13.3%) were found to be increased as compared to group A. Maternal mortality was found to be high in group B -5(16.6%) as compared to group A- nil. Maternal morbidity was also found to be increase in group B- 13(43.3%) cases as compared to group A- 4(13.3%). Subsequent menstrual cycles were found to be normal in group A - 20(90%) indicating non effect on gonadal function. CONCLUSION: This comparative analysis showed that by advocating this noble approach

Management of major degree placenta previa during LSCS operation - a new surgical technique (Dutta's)

Objectives: Evaluation of a new surgical technique (Dutta’s) to prevent postpartum hemorrhage due to major degree placenta previa during cesarean section. Methods:This study was conducted at tertiary care hospital(JNM,&amp; NSGH) at Kalyani, Nadia, West Bengal, India from the period January 2004 to December 2009.Ninty four (94) cases diagnosed to be having major degree placenta previa, undergoing LSCS operation, were selected for this study. New surgical technique(Dutta’s) was adopted in a stepwise manner = delivery of baby &gt; bilateral uterine artery ligation by chromic catgut no-1 suture &gt;injection tranexamic acid (1000mg) IM &gt; injection oxytocin in intravenous infusion(10 units 30 drop /min in 500 ml of 5% dextrose)&gt;delivery of placenta and membranes&gt; checked properly if any tear or laceration in placental site &gt; closure of uterine wound was done after securing bleeding from placental bed &gt;closure of abdomen in layers by polyglycolic acid no 1 suture. Results: It was observed from this study that good effectiveness to control bleeding and intra operative blood loss less than 300cc were seen in 89(94.68%) cases respectively. Six (6.3%) cases required underlying interrupted suture for bleeding from placental bed. Subtotal cesarean hysterectomy was advocated in 3(3.28%) cases due to failure to control uterine atony. Immediate post operative bleeding less than 200c.c was found in 81 (86.16%) cases. Maternal mortality was found to be absent. Maternal morbidity was seen in 12(12.76%) cases. Subsequent menstrual cycles were found to be normal in 80(87.91%) cases and repeated pregnancy was observed in 26(28.57%) cases indicating non effect on gonadal function. Conclusion: Dutta’s new surgical technique during LSCS for major degree placenta previa was found to be simple, safe and quick procedure. It reduces perfusion pressure, permits time for further steps, thereby avoiding unnecessary ligation of bilateral internal iliac arteries and cesarean hysterectomy. Maternal mortality and morbidity were also found to be reduced. This technique is suitable for rural based hospital in absence of adequate blood transfusion facility.DOI: http://dx.doi.org/10.3126/ajms.v4i2.7958 Asian Journal of Medical Sciences 4(2013) 1-7

Single layer closure of the uterine wound at caesarean section. A safe technique?

Single layer closure of the uterine wound at caesarean section. A safe technique?

Indication and outcome of relaparotomy after caesarean section

The objective was to determine the indicatons, management and the outcome among the patient who underwent relaparotomy after caesarean section and to suggest the way to improve the quality of care. This was a retrospective descriptive study done in a tertiary level referral and teaching hospital, Khulna, Bangladesh, out of 55 cases requiring relaparotomy after caesarean section. Over a period of 15 months from 1st January 2011 to 31st march 2012, 1180 caesarean deliveries were done, out of total 3270 deliveries. During this period, relaparotomy was done in 55 cases. Among these, 10 cases followed caesarean delivery at this institute itself, while 45 cases have had caesarean delivery at peripheral hospitals. Postpartum haemorrhage in 31 cases (56.36%) and rectus sheath haematoma in 8 cases (14.55%) were the leading cause of relaparotomy. Among the 55 cases, 39 had emergency caesarean delivery while 16 had elective operation. Procedures undertaken at laparotomy were hysterectomy in 21 cases (38.18%), resuturing of uterine wound with uterine brace suture in 13 cases(23.63%), bilateral uterine arteries and ovarian vessels ligation in 7 cases (12.73%), drainage of haematoma in 8 cases (14.55%), and repair of anterior abdominal wall &amp; peritoneal toileting in 5 cases (9.09%). A third laparotomy was done in 3 cases of which 2 cases were due to secondary PPH, a negative relaparotomy was done in one case. There were 7 maternal deaths following relaparotomy caused by hemorrhagic shock, septicaemia &amp; renal failure and was 12.73%. Caesarean section is a life saving operation. However maternal mortality and near miss fatality after relaparotomy following caesarean section are common. So, relaparotomy should be considered as a procedure after a near miss fatality of mother. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13625 Bang Med J (Khulna) 2012; 45 : 19-23

The effect of lipoic acid on wound healing in a full thickness uterine injury model in rats

Aim of this study was to investigate the effects of lipoic acid on uterine wound healing by immunohistochemical and biochemical assay in a rat uterine horn model with full thickness injury. Thirty-two female Wistar albino rats were randomised into five groups: Control group, with no intervention; uterine scar group 15days (US15d), uterine scar group 15days+alpha lipoic acid (ALA) (US15d+ALA), uterine scar group 30days (US30d) and uterine scar group 30days+ALA (US30days+ALA). After uterine incision 100mg/kg of ALA was administered by oral gavage for either 15 or 30days. Vascular endothelial growth factor (VEGF) and alpha smooth muscle actin (α-SMA) distribution were evaluated by immunohistochemical methods in tissue and ELISA methods in tissue homogenate. The percentage of α-SMA positive area in US15d+ALA and US30d+ALA groups was significantly higher than US15 and US30d groups. The percentage of VEGF positive area in US15d+ALA group was significantly higher than US15d group and US30d+ALA group was significantly higher than US30d group. Biochemically, α-SMA was significantly higher in the US15d+ALA group when compared to US15d group and higher in US30d+ALA group when compared to US30d group. VEGF was significantly higher in US15d+ALA and US30d+ALA groups when compared to US15 and US30d groups. In conclusion, ALA was found to be effective in enhancing wound healing in uterine full thickness injury.