Delivery of patients with a uterine scar who have undergone cell technology in a previous caesarean section

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Objective: To determine the likelihood of successful spontaneous delivery in women with myometrial scars who had undergone cell technology, that is, mesenchymal stromal cell derived exosomes (MSCE), during a previous caesarean section.

Materials and methods: Group 1 (study group) included 60 pregnant and parturient women who underwent cell technologies. Group 2 (control group) consisted of 100 pregnant and parturient women without exosomal support. In addition, an intra-natal assessment of the scar condition was performed in 71 parturient women, including 19 and 22 women from groups 1 and 2, respectively. In addition, the condition of the lower uterine segment was evaluated by ultrasound in 30 women without a post-caesarean uterine scar in the control group. A suprapubic arrangement of a RAB6-D volumetric convex transducer with a frequency of 2–8 MHz and an intracavitary IC5-9-D transducer with a frequency of 4–9 MHz from the GE Voluson E8 device (USA) was used. The primary endpoints were the course of pregnancy and childbirth in patients in the study and control groups. Secondary endpoints included the results of repeated deliveries of patients with uterine scars with and without the use of cell technologies, i.e., exosomal support.

Results: No infectious or inflammatory complications were observed in postpartum women who underwent cell technologies, while 6/100 (6 %) patients in group 2 had symptoms of metroendometritis, which required hospitalization and inpatient treatment. Two patients in group 2 (2%) developed lochiometra, as confirmed by ultrasound and office hysteroscopy. The rate of successful vaginal deliveries was 63.6% (14/22) in the group with prior exosomal support, compared to 20.7% (6/29) in the control group.

Conclusion: This study demonstrated the feasibility of using cell technologies, specifically exosomes derived from mesenchymal stromal cells of placental origin, to improve the repair of postoperative myometrial scars and increase the likelihood of safe spontaneous delivery in women with a history of abdominal delivery. This finding suggests the potential of reducing the cesarean section rate in patients with a post-cesarean uterine scar.

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Sobre autores

Oleg Pekarev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: o_pekarev@oparina4.ru
ORCID ID: 0000-0001-7122-6830

Dr. Med. Sci., Professor, Deputy Director of the Institute of Obstetrics

Rússia, Moscow

Igor Baranov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: i_baranov@oparina4.ru
ORCID ID: 0000-0002-9813-2823

Dr. Med. Sci., Professor, Head of the Department of Scientific and Educational Programs

Rússia, Moscow

Evgenia Pekareva

Novosibirsk City Clinical Perinatal Center

Autor responsável pela correspondência
Email: o_pekarev@oparina4.ru
ORCID ID: 0000-0002-6335-2121

Dr. Med. Sci., Obstetrician-Gynecologist

Rússia, Novosibirsk

Denis Silachev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: o_pekarev@oparina4.ru
ORCID ID: 0000-0003-0581-9755

Dr. Bio. Sci., Head of the Cell Technologies Laboratory

Rússia, Moscow

Ivan Pozdnyakov

Novosibirsk City Clinical Perinatal Center

Email: o_pekarev@oparina4.ru
ORCID ID: 0000-0003-0600-3053

Dr. Med. Sci., Professor, Chief Physician

Rússia, Novosibirsk

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