INCONSISTENT UTERINE SCAR AFTER CESAREAN SECTION: CAUSES OF FORMATION AND TREATMENT POLICY

The distinguishing feature of present-day surgical obstetrics is the rising number of cesarean resections, the indication for which is an inconsistent uterine scar in more than 70% of cases. Objective. To analyze the outcomes of cesarean section (CS) at different postoperative stages. Subject and methods. A retrospective analysis was made in 479 patients after CS: in 52 puerperas after CS in the postpartum period (within 70 postoperative days), in 42 patients with a postcesarean section uterine scar when planning a next pregnancy, and in 385 pregnant women with a uterine scar after postcesarean section CS during full-term pregnancy. The uterine scar was evaluated from clinical and echoscopic findings. Results. The CS procedure, in particular a method for suturing the incision on the uterus, plays an important role in its scar formation. When individual musculomucosal sutures were used after the Eltsov-Strelkov method, the frequency of inconsistent scars was 38.5% (35/91); when individual musculomucosal sutures and an uninterrupted suture were applied to the uterine fascia proper, it was 13.2% (10/76); when the uterine incision was closed with one-two-layer uninterrupted sutures, inconsistent scars occurred in 95.4% of cases (105/110) and when uterine closure was done using a Reverden uninterrupted suture, they did in 95% (19/20). Conclusion. For the prevention of additional injury, the Gusakov-Zanchenko uterotomy should not be employed especially in CS during labor and delivery. To create the optimal conditions for forming a uterine suture/scar, it is expedient to close the incision with individual sutures, by using an absorbable synthetic suture material.

cesarean section, cesarean section complications, uterine scar, secondary uterine sutures, lower uteroplasty