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Matukhin V.I.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Malysheva A.A.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Reznik V.A.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Rukhliada N.N.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Taits A.N.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Krylov K.Y.

St. Petersburg Research Institute of Emergency Medicine I. I. Dzhanelidze

Novitskaya N.Y.

St. Petersburg Research Institute of Emergency Medicine I. I. Dzhanelidze

The hypothesis of formation of a non-sustainable curve on the uterus after cesaranean section as a possible risk factor for the development of placental insight

Authors:

Matukhin V.I., Malysheva A.A., Reznik V.A., Rukhliada N.N., Taits A.N., Krylov K.Y., Novitskaya N.Y.

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Journal: Russian Journal of Human Reproduction. 2020;26(6): 114‑121

DOI: 10.17116/repro202026061114

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To cite this article:

Matukhin VI, Malysheva AA, Reznik VA, Rukhliada NN, Taits AN, Krylov KY, Novitskaya NY. The hypothesis of formation of a non-sustainable curve on the uterus after cesaranean section as a possible risk factor for the development of placental insight. Russian Journal of Human Reproduction. 2020;26(6):114‑121. (In Russ.)
https://doi.org/10.17116/repro202026061114

 
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OBJECTIVE

To form a hypothesis of the occurrence of an inconsistent scar on the uterus when using various methods of suturing the uterus and suture material during a cesarean section.

MATERIAL AND METHODS

Based on the SPbGPMU Perinatal Center and SPb Research Institute of Emergency Medicine. I.I. Dzhanelidze from January 2019 to August 2019 carried out a morphological study of 50 histological materials of a scar on the uterus after cesarean section, of which 30 (60%) were a scar on the uterus of normal thickness and 20 (40%) a thinned scar on the uterus. The parameters of the thickness of the scar on the uterus and signs of inconsistency were assessed instrumentally by ultrasound in the third trimester of pregnancy before the caesarean section — a scar less than 3 mm thick was considered inconsistent. The histological material was obtained by operating a biopsy of the uterine scar during a cesarean section.

RESULTS

After the morphological examination of the uterine scar, in 17 cases out of 20 (85%) in the group of thinned scars, granulomatous inflammation with foreign inclusions, most likely the remnants of suture material, was found, whereas in none of the preparations from the group of scars of normal thickness, traces of formation no granulomatous inflammation was found. In 18 preparations out of 20 (90%) from the group of thinned scars, a violation of the architectonics of the layers of the myometrium was found, while in the group of normal scars, this violation of the architectonics was observed only in 2 cases out of 30 (6.7%). In 20 out of 50 cases (40%), among all histological materials, the inclusion of the endometrial stroma with decidual transformation in the myometrium was found, which is also a possible sign of thinning of the scar on the uterus after cesarean section. These changes were visualized both in the group of thinned scars and in the group of regular scars.

CONCLUSION

According to our data of a morphological study, during scar thinning, granulomatous inflammation with inclusions of foreign bodies was revealed in 85% of cases, which indicates that the properties of the suture material, namely the rate of its biodegradation, can affect the quality of scar formation on the uterus and in the future. lead to scar failure. The hypothesis we have formed is based on the fact that transmural conduction of threads with a single-row method of suturing a wound on the uterus can contribute to transmural epithelialization of the passages, especially when using long-term absorbable suture material.

Keywords:

caesarean section
scar on the uterus
inconsistency of the scar on the uterus
ingrowth of the placenta
suture material
stitching of the uterus

Authors:

Matukhin V.I.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Malysheva A.A.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Reznik V.A.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Rukhliada N.N.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Taits A.N.

St. Petersburg State Pediatric Medical University of the Ministry of Health of Russia

Krylov K.Y.

St. Petersburg Research Institute of Emergency Medicine I. I. Dzhanelidze

Novitskaya N.Y.

St. Petersburg Research Institute of Emergency Medicine I. I. Dzhanelidze

Received:

04.04.2020

Accepted:

14.08.2020

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