Optimizing pre-pregnancy management of patients with post-cesarean section uterine scar


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Abstract

Objective: To develop a strategy for pre-pregnancy management of patients with a post-cesarean section uterine scar. Materials and methods: A multicenter study including 209patients planning pregnancy naturally or by assisted reproductive technologies. The patients met the inclusion/exclusion criteria and were managed at a pre-pregnancy stage in clinical hospitals of the Mother and Child Group of Companies from 2018 to 2021 and. Baseline clinical evaluation included medical history taking, contrast sonohysterography on days 5-8 of the menstrual cycle, and pelvic magnetic resonance imaging on days 5-8 of the menstrual cycle. The statistical analysis was performed using the IBM SPSS Statistics v22 software (IBM Corp., USA). Results: We developed a scoring scale for grading scar niche severity. Based on this scoring scale, the patients were classified into three groups: in group I [n=107/209 (51.2%)] surgery at the pre-pregnancy stage is not recommended, in group II [n=36/209 (17.22%)] hysteroscopic uterine metroplasty is recommended, and group III [n=66/209 (31.58%)] laparoscopic uterine metroplasty is recommended. There were statistically significant differences between the groups of patients regarding the prevalence of clinical complaints, data on residual myometrium thickness, and niche volume. There was a high level of agreement between contrast sonohysterography and magnetic resonance imaging. Conclusion: The proposed scoring scale for grading scar niche severity helps a clinician choose the optimal managing strategy for the patient at the pre-pregnancy stage. Further clinical studies are needed to determine optimal threshold values of the uterine scar defect to select between a hysteroscopic and laparoscopic approach and evaluate the effectiveness of the proposed management strategy based on the results of prospective data regarding the elimination of gynecological symptoms, restoration of fertility, and assessment of obstetric complications.

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About the authors

Mark A. Kurtser

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Lapino Clinical Hospital, Mother and Child Group of Companies

Academician of the RAS, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Pediatric Faculty

Natalya M. Egikyan

Lapino Clinical Hospital, Mother and Child Group of Companies

MD, PhD, Gynecologist, Head of the Department of Gynecology

Natalya A. Savelyeva

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Lapino Clinical Hospital, Mother and Child Group of Companies

Email: nats4644@mail.ru
PhD Student at the Department of Obstetrics and Gynecology, Pediatric Faculty

Maria A. Vatagina

Lapino Clinical Hospital, Mother and Child Group of Companies

Gynecologist

Ekaterina S. Pisarskaya

Lapino Clinical Hospital, Mother and Child Group of Companies

Diagnostic Medical Sonographer

Igor V. Platitsyn

Lapino Clinical Hospital, Mother and Child Group of Companies

MD, PhD, Head of the Department of Diagnostic Imaging

Yuliya Yu. Kutakova

Lapino Clinical Hospital, Mother and Child Group of Companies

MD, PhD, Medical Director for Organizational

Anna O. Logunova

Lapino Clinical Hospital, Mother and Child Group of Companies

Gynecologist

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