Clinical and morphological features of scar tissue of the uterus.
One of the key issues for increase uterine scars is the rapid and unwarranted Caesarean sections (CS) as in the world same in Ukraine. One of the way to reduce CS is delivery truth vaginal births in women with previous surgical intervention on the uterus or after CS. The ability of scar on the uterus is the main criterion for an attempt to vaginal birth. Objectivе — to analyze the structural changes of the scar tissue of the uterus. Pathomorphological examination was fragments of uterus scar. The material was fixed in a 10% solution of neutral colored formalin (pH 7.4) carried out according to the standard procedure, poured into paraffin. From the paraffin blocks on the rotary microtome of HM 325, serial histological sections were made in a thickness of 4–5 microns, which were stained with hematoxylin and eosin. Scar tissue was additionally stained for Van Gieson, according to Masson. Fragments of scar tissue were subjected to an immunohistochemical study (IGHS) using monoclonal antibodies (MATs) to CD31 to assess the degree of vascularization vascular component and α-SMA for assessing the condition smooth muscle tissue. Having conducted a comprehensive pathomorphological study in two groups, one can state that in group 1 the pathomorphological picture of the changes in the scar was minimal and confirmed by the retained proportions between the fibrous tissue and the smooth muscle fibers, as well as their characteristic location. Muscle fibers with minimal pathological changes, developed by compensatory changes from the side of the vascular complex. These data were confirmed by conducting IGHS from MAT to CD31, which gives a pronounced positive response in the endothelial layer of the vascular wall, forming continuous cell chains. IGHS from MAT to α-SMA exhibits pronounced homogeneous intensive expression, indicating minimal pathological changes in muscle fibers. These figures make it possible to talk about the ability of uterine scar in 61% in group 1, as opposed to in group 2, this result was only 41%. As a result of a comprehensive clinical and morphological study, it was found that the majority of women in group 1, according to the morphological and histological characteristics, had a capable scar on the uterus, that is, potentially could be considered as a reserve for vaginal birth in women with uterine scar after the previous CS. In the second group, a significant proportion of women confirmed the correlation of regenerative and degenerative changes in the tissues of postoperative scar, indicating prevalence of fibro-sclerotic changes and insufficient vascularization, that is, it states the validity of operational resolution.
2. Mihalevich, S. I., Markovskaya, T. V., & Ruseckaya, V. M. (2011). Osobennosti obsledovaniya i vedeniya beremennosti i rodov u zhenshin s operirovannoj matkoj (ucheb.-metod. posobie) [Features of the examination and management of pregnancy and childbirth in women with uterus operated on]. Minsk.
3. American College of Obstetricians and Gynecologists (2014). Safe Prevention of the Primary Cesarean Delivery. Obstetric care consensus №1. Obstet. Gynecol., 123, 693–711.
4. Hodin, S., Chan, T. H. (2017). Women and Health Initiative. The Global Epidemic of Unnecessary Cesarean Sections (Part 1). Retrieved from https://www.mhtf.org/2017/01/24/the-global-epidemic-of-unnecessary-cesarean-sections-part-1/.
5. Kotaska, A. (2015). Кесарево сечение или роды через естественные родовые пути в 20-м веке. Entre Nous. Европейский журнал сексуального и репродуктивного здоровья, 81, 8–10. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/288305/Cesarean-Section-or-Vaginal-Delivery-in-the-21st-Century-rus.pdf?ua=1.
This work is licensed under a Creative Commons Attribution 4.0 International License.