Echographic characteristics of the uterus in the early and late period after abdominal delivery

A search for optimal criteria in assessing the morphofunctional status of the uterus in patients after abdominal delivery does not lose its relevance now. For this purpose, a study of the echographic characteristics reflecting the status of the organ in the early and late postoperative period not only will extend our views on the specific features of the process of uterine involution and the pathophysiological mechanisms of scar formation, but will also allow the management of subsequent pregnancies and deliveries to be predicted. Objective. To investigate the echographic characteristics of the uterine status in the early and late period after cesarean section (CS). Subjects and methods. The echographic parameters of a scar and the uterus were analyzed in 115 puerperas with uncomplicated postpartum (n = 30) and postoperative (n = 85) periods on day 4 and three months after spontaneous (n = 26) and surgical (n = 18) delivery. Results. On day 4 after CS, the women with spontaneous labor showed significant differences in the anteroposterior sizes of the wall of the uterus in the area of its isthmus (p = 0.023) and in the length of the cervix uteri (p = 0.028) as compared with ultrasound parameters. Three months after surgery, only the width of the uterus was significantly smaller than that in the women after spontaneous labor (p = 0.0001). At the same time, the anteroposterior size of the uterus (р = 0.0082) and the thickness of its anterior (р = 0.025) and posterior (р = 0.0001) walls and myometrium in the scar area (р = 0.0001) proved to be significantly larger. No differences among the groups were found in the volume of the uterus (p = 0.74). Three months following CS, the scar area displayed remnants of suture materials in 6.67% of cases and niches in 6.67%. Conclusion. CS surgery affected the processes of uterine involution in the late postoperative period. The scar formation-induced uterine anatomic and functional differences found at ultrasound study are also detected 3 months following delivery. The echographic signs of incomplete and inadequate regenerative processes in 13.34% of cases necessitate the continuation of studies identifying the determinants of the formation of scar incompetence and those preventing these disorders. The described features should be kept in mind when evaluating the morphofunctional status of the uterus in women after CS and predicting the course of a subsequent pregnancy and labor.

cesarean section, scar on the uterus, echographic signs, postpartum period