Intraoperative prevention of uterus suture disability

Background. One of the main problems of modern obstetrics is the high incidence of uterine scars. Objective: to prevent the development of suture failure in the uterus by intraoperative prophylaxis using argon plasma coagulation (APC). Methods. In a prospective, open, comparative case-control study included 180 patients with a scar on the uterus after a previous cesarean section. Of these (n=90, group I), argon plasma coagulation was used during the previous cesarean section (CS), the rest (n=90, group II) of the CS was performed according to the traditional method. The uterus ultrasound was performed in the period of 38/39 weeks of gestation, during the second CS, areas of 2.0x1.0 cm were dissected from the scar area, which were subjected to morphological examination and evaluated on a special scale, the involution suture index was calculated using the method V.A. Kramarsky. Results. A pronounced effect of the effects of APC on angiogenesis in the wound area, an increase in the number of myocytes in the rumen was obtained. Thus, the average score of a scar in group I was 9.8±1.18 against 7.9±0.46 points - in II (p=0.05). In 56% (50/90) and in 28.9% (26/90) of cases, respectively, myocyte invasion of the scar area was estimated at 2-3 points (p=0.005). Active angiogenesis with numerous vessels was found in 37.8% (34/90) and 20.0% (18/90), respectively (p=0.001). At the same time, a moderate number of vessels prevailed (in 64.4%, 58/90 vs. 40%, 30/90) cases (p=0.04). Conclusion. The use of APC for intraoperative treatment of a suture on the uterus increases the volume of muscle tissue and the depth of its penetration into the uterine scar, improves angiogenesis, and reduces the incidence of postoperative inflammatory complications, which contributes to the full regeneration of myometrium.

uterine scar, argon plasma coagulation, reparative processes of myometrium, cesarean section