ECHOGRAPHIC AND ELASTOGRAPHIC CHARACTERISTICS OF THE UTERUS IN RELATION TO ITS INTEGRITY RECOVERY TECHNIQUES AFTER CESAREAN SECTION

Numerous studies indicate that surgical techniques used to suture uterine wound affect the process of cicatrization. At present, there is no consensus as to optimal uterine wound suturing techniques. The study of the intraoperative features and ultrasound and elastographic characteristics of the uterus in the early and late postoperative period in relation to the type of an applied suture allows expansion of an idea on the impact of surgical delivery on the uterus, the course of cicatrization, and prediction for further pregnancy. Objective. To investigate thefeatures of the uterine status and the possibilities of using echography and elastography in the early and late postoperative period to assess myometrial changes in relation to the type of an applied suture. Subjects and methods. The investigation enrolled 129 women after cesarean section. The uterus was closed with a one-row continuous suture in 57patients, with a one- row locking suture (after Reverdin) in 30 patients, and with a double-row suture in 42. The uterus was stitched by suturing all its layers (perimetrium, myometrium, and endometrium) in 102 patients; the uterine wall was restored without pricking the endometrium in 27. Thirty-four patients underwent a control examination 3 months after cesarean section. During cesarean section, the uterine wall was restored using one-row stiches in 15 of them, one-row locking stitches in 9, and double-row stiches in 10. The endometrium was pricked in 22 patients and was not in 7. В-mode ultrasonography was carried out at Stage 1. Tissue elasticity was estimated in real-time, by using compression elastography and calculating the elastographic index (El) at Stage 2. Examinations were performed in all the 129 cases on day 4 after delivery and in 34 also three months following cesarean section. Results. The surgical duration was noted to be shorter when applying one-row blanket sutures or one-row locking sutures than double-row ones (p = 0.005) and (p = 0.0172). On day 4postsurgery, hemoglobin values were higher when a one-row blanket suture had been used than a locking one had (p = 0.03). On that day, the cervical length was shortest after applying a double-row suture. Ultrasound assessment 3 months after cesarean section provided no statistical significant data in relation to the uterine wall suturing method. However, the highest El was seen in the women undergoing the double-row uterine suturing technique. Conclusion. The benefits of the one-row procedure for suturing the uterine wall are a shorter surgical duration and higher hemoglobin and hematocrit values in the early postoperative period. In this period, the cervical length was shorter in the women who had undergone the double-row uterine suturing technique than in those who had a one-row technique. Despite the fact that there were differences in myometrial thickness at the site of a uterine scar in the postoperative period; the stiffness values for the tissues in this area were highest when the double-row uterine suturing techniques had been used. There were differences in the status of a uterine scar after applying the one-row or double-row uterine suturing techniques. It is necessary to continue investigations to determine how the found differences are associated with the morphofunctional status of the scar during the next pregnancy.

cesarean section, seam on the uterus, US seam, elastography