OPTIMIZATION OF DIAGNOSTICS OF POSTOPERATIVE SCAR DEFECT ON THE UTERUS IN THE LONG TERM AFTER ABDOMINAL DELIVERY
DOI:
https://doi.org/10.11603/24116-4944.2025.1.15333Keywords:
cesarean section, uterine scar defect or «isthmocele», diagnostics, dysmenorrhea, «niche» of the scar area, chronic endometritisAbstract
The aim of the study – to optimize diagnostic approaches for assessing postoperative scar defects after cesarean section (CS) in non-pregnant patients and to identify prognostically significant criteria in terms of reproductive function disorders.
Materials and Methods. The prospective study included 90 patients with impaired reproductive potential, of which 50 feamles with secondary infertility and a postoperative scar defect after CS (the main group), the comparison group included 40 conditionally healthy females who underwent a routine examination for the male factor of infertility. The study was performed in accordance with standards and guidelines, covering data from medical history, physical examination, gynecological examination, instrumental (transvaginal ultrasound, dopplerometry of uterine vessels, if necessary - sonohysterography with saline infusion, office hysteroscopy) and laboratory methods.
Results and Discussion. In the structure of reproductive health disorders, infertility lasting more than 5 years was observed in 38.0 % of cases in the main group, unsuccessful attempts of IVF program (18.0 %; χ2 – 3.95; p<0.05), spontaneous miscarriages (24.0 %; χ2 – 4.75; p<0.03), stillbirths (10.0 %), recurrent miscarriages (8.0 %), premature births (18.0 %). The most significant symptoms of the “operated uterus syndrome” were: polymenorrhea (48.0 %; χ2 – 11.25; p<0.001), dysmenorrhea (52.0 %; χ2 – 6.94; p<0.01), chronic pelvic pain (24.5 %; χ2 – 4.75; p<0.02), urogenital disorders (18.0 %; χ2 – 3.95; p<0.05), abnormal uterine bleeding (42.0 %; χ2 – 11.82; p<0.001). The location of the scar area on the uterus at the level of the internal os was noted in 72.0 %, and in 28.0 % – 2.7 mm above the internal os. The parameters of the main anatomical values of the uterine scar area demonstrate statistically significant differences when using different diagnostic approaches. The combination of 2D/3D sonography allowed to establish the residual minimum thickness of the myometrium in the scar area <3 mm in more than half of the observations (58.0 %). The following sonographic signs of inflammatory changes were noted: change in the thickness of the endometrium in different areas (36.0 %), pronounced vascular pattern and zones of mucosal hyperemia (26.0 %), micropolyposis and polypoid growths (16.0 %), focal mucosal hypertrophy (14.0 %), pinpoint hemorrhages (18.0 %). Thorough assessment of the scar area, considering the data of an optimized diagnostic approach, allows predicting the likelihood of reproductive disorders in the category of females with secondary infertility and an operated uterus.
Conclusions. A postoperative uterine scar defect should be suspected in women with bloody discharge, dysmenorrhea, pelvic pain, or infertility with a history of previous cesarean section. The diagnostic approach should include a combination of transvaginal sonography with recommended measurements of the postoperative scar zone parameters, sonohysterography with saline infusion and visual techniques – hysteroscopy. The use of magnetic resonance imaging is an informative, but economically limited diagnostic method and is advisable to use in difficult cases at the stage of preoperative preparation for the selection of surgical technique for defect correction.
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