Clinical and morphological variants of insufficient uterine scar after cesarean section

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Objective: To explore the morphological features and clinical manifestations of insufficient uterine scar after cesarean section.

Materials and methods: The study included 109 patients with uterine scar after cesarean section. They were divided into four groups depending on the clinical and morphological features of insufficient uterine scar: group I – “vascular”type (n=23), group II – “connective tissue” type (n=39); III – “inflammatory” type (n=27), and Group IV – the comparison group (n=20). Histological and histomorphological evaluation of excised scar tissue, clinical assessment of anamnestic indicators, and statistical data analysis were performed.

Results: Three main morphological variants of insufficient uterine scar were identified – "inflammatory," "vascular," and "connective tissue." The clinical and morphological parallels of insufficient uterine scar were assessed taking into account the histological variant. The patients with the "vascular" type of insufficient uterine scar had a history of irregular menstrual cycles (r=0.71; 95% CI 0.81;0.89 p<0.001). The main indication for delivery was the risk of uterine rupture along the scar (r=0.67; 95% CI 0.78;0.95 p<0.001). The patients with the "connective tissue" type of insufficient uterine scar underwent the first cesarean section due to abnormal labor (r=0.81; 95% CI 0.65;0.74 p<0.001). Uterine scar insufficiency – thinning of the uterine scar (< 2 mm) was detected by ultrasound. At the same time, the clinical picture showed no risk of uterine rupture along the scar (r=0.88; 95% CI 0.76;0.85 p<0.001). The "inflammatory type" of insufficient uterine scar correlated with recurrent miscarriage in history (r=0.65; 95% CI 0.58;0.83 p<0.001) and fetal distress in current pregnancy (r=0.63; 95% CI 0.61;0.81 p<0.001).

Conclusion: The obtained data indicate that there is a need for an in-depth study of the pathogenetic mechanisms of uterine scar formation and the development of a prediction model.

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Sobre autores

Vitaly Nesterov

Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia

Autor responsável pela correspondência
Email: dr.nesterov2014@yandex.ru

PhD, Senior Researcher, Head of the Obstetric Department

Rússia, Yekaterinburg

Galina Malgina

Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia

Email: galinamalgina@mail.ru
ORCID ID: 0000-0002-5500-6296

Dr. Med. Sci., Professor, Scientific Secretary, Leading Researcher

Rússia, Yekaterinburg

Maria Dyakova

Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia

Email: mariadakova40@mail.ru
ORCID ID: 0000-0001-7911-6783

PhD, Junior Researcher

Rússia, Yekaterinburg

Anastasia Grishkina

Sverdlovsk Regional Bureau of Anatomical Pathology

Email: xumukyc.ru@mail.ru
ORCID ID: 0000-0001-7433-2217

PhD, Pathologist, Head of the Department of Pediatric Pathology

Rússia, Yekaterinburg

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2. Fig. 1. Macroscopic signs of uterine scar defects in patients of the examined subgroups (%)

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3. Fig. 2. A (100x magnification, hematoxylin eosin), B, C — “vascular” type of defective scar on the uterus

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4. Fig. 3. A (100x magnification, hematoxylin eosin), B – “connective tissue” type of scar on the uterus

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5. Fig. 4. A (100x magnification, hematoxylin eosin), B - "inflammatory" type of defective scar

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