OBJECTIVE OF THE STUDY
Was to determine the possibility of surgical correction and organ-preserving surgery during pregnancy in the uterine scar after cesarean section, depending on the degree of destructive changes in the myometrium of the anterior uterine wall.
MATERIAL AND METHODS
In 2016—2019, 19 patients with ectopic pregnancy in the area of the uterine scar after cesarean section were examined and operated in the Moscow Regional Research Institute of Obstetrics and Gynecology. All patients underwent a complete clinical and laboratory examination and an expert ultrasound examination. Statistical processing of the research results was carried out using Microsoft Excel, Statistica.
RESULTS
In 2 (10.5%) patients with a gestation up to 7 weeks, typical localization of the ovum in the projection of the «niche» was revealed. In 14 (73.7%) patients with typical localization of the ovum in the projection of the scar after cesarean section, thinning of the myometrium of the anterior uterine wall with a residual myometrium thickness of less than 2 mm, deformation of the anterior uterine wall was revealed. In 3 (15.8%) patients with primary treatment within 10 weeks (1 pregnant woman) and 13 weeks (2 patients) with non-developing pregnancy, signs of chorion ingrowth with total destruction of the lower third of the anterior wall of the uterus, isthmus and partially the upper third of the anterior lip were noted cervix, with signs of chorionic invasion into the bladder wall. Metroplasty with simultaneous abortion by vacuum aspiration during the operation was performed in 14 (73.7%) patients, in 2 (10.5%) cases; vacuum aspiration of the ovum was performed under ultrasound control without metroplasty. And 3 (15.8%) patients underwent hysterectomy due to the lack of technical capabilities for organ-preserving surgery.
CONCLUSION
Early detection of ectopic pregnancy in the area of an inconsistent scar on the uterus allows vacuum aspiration. When ultrasound signs of chorion ingrowth are detected, it is necessary to perform metroplasty with simultaneous termination of pregnancy to preserve reproductive function.
