Clinical and morphological assessment of uterine scars after cesarean section in patients with gynecological and extragenital diseases

Abstract

Introduction. The article studies excised scars on the uterus after Gusakov’s and Stark’s cesarean sections, with an assessment of the impact of gynecological and extragenital diseases on the viability of the scar. Cesarean scar pregnancy is known to be a frequent indication for surgical delivery. However, if the uterine scar is stable, it is advisable to deliver the baby through the natural birth canal. At present, natural delivery of pregnant women with a scar on the uterus through natural childbirth is an important task in modern obstetrics. Thus, the aim of our study was to perform a multifaceted clinical and morphological evaluation of uterine scars after cesarean section in patients with gynecological and extragenital diseases. Materials and methods. We analyzed samples of scar tissue on the uterus after cesarean section performed in 68 patients. A pathomorphological study was carried out with Mallory staining with hematoxylin and eosin. Immunohistochemical study was performed with antibodies to collagen IV, vimentin, desmin, and von Willebrand factor. Results. In 56 out of 68 puerperas (82.3%), the scars on the uterus were stable with complete replacement of the defect with muscle (63.2%) or connective tissue (19.1%), regardless of the operation duration and the suturing technique. This was confirmed by additional diagnostic methods (Mallory stain and IHC with an antibody panel). We found that connective tissue dysplasia, which is indirectly indicated by the presence of myopia in 5 patients with wealthy fibrous scars, can affect excessive connective tissue in the scar. Twelve out of 68 puerperas (17.6%) had the scars (according to pathomorphological criteria) with severe edema, hemorrhages, tissue with different fibers, and uneven thinning. These patients had extragenital diseases, such as type 2 diabetes mellitus (36.4%) and anemia (18.2%). We did not reveal any influence of existing gynecological diseases on the scar stability. Conclusion. The healing of the postoperative uterine wound was mostly influenced by extragenital diseases (type 2 diabetes mellitus, anemia, connective tissue dysplasia) associated with metabolic disorders and having systemic effects on the body. The Gusakov’s or Stark’s incision closure techniques did not affect the quality of the scar. However, the scars after cesarean section using the Stark incision technique had significantly more connective than muscular tissue. Keywords: cesarean section, incompetent uterine scar, type 2 diabetes mellitus, anemia, connective tissue dysplasia, pathological examination, immunohistochemical study