Histological determinants of trial of labor after cesarean delivery


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Abstract

Objective: Ta identify histological determinants (uterine scar specifics) af trial af labor after cesarean section (CS). Materials and methods: This prospective study was conducted in 2013-2019 in Moscow maternity hospitals No. 68 and No. 29. The study included 272 women who wanted ta have vaginal delivery but underwent CS. Of them, 182 underwent prelabar CS (vaginal delivery was either nat cansidered ar nat attempted), and 90 had intrapartum CS (vaginal delivery was attempted but canverted ta CS). Results: Scar histology was correlated with a combination af highly diverse clinical, anamnestic, and maternal ultrasaund factors. They included number af years lived, age af menarche, pre-pregnancy body mass index (BMI), number af phenotypic manifestations af undifferentiated connective tissue dysplasia, ordinal number af deliveries, interval between previous CS and present pregnancy, estimated fetal weight, amniatic fluid index, minimal scar thickness, right uterine artery resistance index before labor (Wilks' Lambda=0.006, p<0.001). In the attempted trial af labor, the predominance af fibrous tissue was associated with a lower age af menarche, higher prepregnancy BMI, and fifth-minute Apgar scare. Conclusion: Myametrial reparatian after CS characterizes the bady as a whale. The histalagy af the uterine scar after CS cambines prepregnancy, gestatianal, and intrapartum factars beyand thase that were surgically determined. Myometrium histology is not an argument far past factum justifying ar challenging attempted trial af labor: the prevalence af muscle tissue, muscle tissue with foci af fibrosis, ar fibrous tissue is comparable.

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About the authors

Yulia D. Vuchenovich

N.E. Bauman City Clinical Hospital No. 29, Moscow Department of Healthcare; Peoples' Friendship University of Russia

Email: vuchrd15@mail.ru
PhD, Associate Professor at the Department of Obstetrics and Gynecology with a course in Perinatology, Medical Institute; Head of the Department of Pathology of Pregnant Women

Vladislava A. Novikova

Peoples' Friendship University of Russia; H-Clinic

Email: vladislavan@mail.ru
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology with a course in Perinatology, Medical Institute

Victor E. Radzinsky

Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru
Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology with a course in Perinatology, Medical Institute

Mikhail I. Vasilchenko

M.P. Konchalovsky City Clinical Hospital, Moscow Department of Healthcare

Email: vasilhenko@mail.ru
Dr. Med. Sci, Deputy Chief Physician for Surgery

Nadezhda V. Trykina

M.P. Konchalovsky City Clinical Hospital, Moscow Department of Healthcare

Email: n.tryckina@yandex.ru
Head of the Department of Anatomic Pathology

Nadezhda M. Startseva

Peoples' Friendship University of Russia

Email: n.startseva@yahoo.com
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology with a course in Perinatology, Medical Institute

Irina A. Yarotskaya

M.P. Konchalovsky City Clinical Hospital, Moscow Department of Healthcare

Email: yrotskayia@zdrav.mos.ru
PhD, Chief Physician

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