Scar malformation and disorganization in the uterine wall in the presence of undifferentiated connective tissue dysplasia are a cause of pregnant uterine wall rupture
- Authors: Osipenkova T.K.1, Demura T.A.2
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Affiliations:
- Russian Center for Forensic Medicine
- Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
- Issue: No 7 (2016)
- Pages: 105-110
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/247779
- DOI: https://doi.org/10.18565/aig.2016.7.105-110
- ID: 247779
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Abstract
Background. Connective tissue disease gives rise to a great number of human diseases. Pregnant women with connective tissue dysplasia are prone to scar tissue disorganization and microcirculatory bed pathology with the changes manifesting in the larger vessels too. In forensic medical practice, there have been no described cases of vascular malformations detected in the gravid uterus in the presence of undifferentiated connective tissue dysplasia with an incompetent uterine scar, which are complicated by antepartum uterine wall rupture, hemorrhagic shock, and fetal death. Case report. The authors give their own case of uterine vascular malformation in a 41-year-old woman with undifferentiated connective tissue dysplasia and uterine scar disintegration (myomectomies in 2002 and 2006), which were responsible for histopathologic uterine rupture. The investigation used clinical, morphological, and immunohistochemical examinations that revealed types I, III, and IV collagens in the rupture area. Immunohistochemical examination showed the expression mainly of type III collagen and that of type IV collagen in the wall of the described vessels. Type I collagen accumulated chiefly in the adjacent myometrium. High type III collagen expression was determined in the rupture area. Thus, it was established that there was vascular malformation in the uterine wall and undifferentiated connective tissue dysplasia with the uterine wall scar being disintegrated and with the choreal and decidual tissues penetrating deeply into the thickness of the uterine wall in the area of malformed vessels with uterine wall rupture. Conclusion. In undifferentiated connective tissue dysplasia, type III collagen (embryonic collagen) accumulates in the scar tissue, which facilitates the invasion of chorionic villi into the uterine wall in an old scar area. In addition, vascular malformations gave rise to wall ischemia, which also aggravated the processes of connective tissue disorganization and caused uterine rupture.
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About the authors
Tamara K. Osipenkova
Russian Center for Forensic Medicine
Email: osipenkova@rc-sme.ru
MD, physician-forensic expert of the highest category, head of the department of histology
Tatiana A. Demura
Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: demura-t@yandex.ru
MD, senior researcher of the 1st pathology department
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