ORIGINAL TECHNIQUES FOR NICHE CORRECTION AFTER TWO CESAREAN SECTIONS


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Abstract

Background. It is important to develop new methods for correcting the postoperative uterine scar niche after cesarean section. Case report. The paper describes a case of a 27-year-old patient with a history of two previous caesarean sections. Transvaginal ultrasound and MRIrevealed two postcesarean uterine scar defects at different levels: in the isthmus area and at 15 mm above the level of 17.0 and 13.6 mm internal orifices with the residual myometrial thickness above the defect being 2.6 and 2.9 mm, respectively. Laparoscopy was performed. The special feature of the operation was to locate a thinned uterine scar, by using the original technique for transilluminating the scar area with a LED fiber-optic stent. This technique involved transillumination using a fiber-optic catheter connected to a light source in order to locate the area of a thinned uterine scar without the need for preliminary hysteroscopic imaging. Conclusion. A laparoscopic approach can be considered as the procedure of choice for the repair of a large myometrial defect with residual myometrial thinning in the presence of more than one inconsistent uterine scar.

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About the authors

Vitaly A. Reznik

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: vitaliy-reznik@mail.ru
PhD, Associate Professor, Department of Obstetrics and Gynecology, Chief Physician of the Clinic 194100, Russia, Saint Petersburg, Litovskaya str., 2

Anna A. Malysheva

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: malisheva.anyuta@yandex.ru
Gynecologist, Department of Obstetrics and Gynecology 194100, Russia, Saint Petersburg, Litovskaya str., 2

Valeriy I. Matukhin

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val-matukhin@mail.ru
graduate student, Department of Obstetrics and Gynecology 194100, Russia, Saint Petersburg, Litovskaya str., 2

Nikolai N. Rukhliada

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: nickolasr@mail.ru
MD, PhD, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology 194100, Russia, Saint Petersburg, Litovskaya str., 2

Anna N. Taits

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: annataitsl@rambler.ru
MD, PhD, Assistant Professor, Department of Obstetrics and Gynecology 194100, Russia, Saint Petersburg, Litovskaya str., 2

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