head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue1
Subject Area: Medicine
DOI: 10.5272/jimab.2019251.2433
Published online: 21 March 2019

Original article

J of IMAB. 2019 Jan-Mar;25(1):2433-2437
Elitsa Gyokova1ORCID logo Corresponding Autoremail, Yordan Popov1ORCID logo, Yoana Ivanova-Yoncheva1ORCID logo, Anton Georgiev1ORCID logo, Miroslava Dimitrova1ORCID logo, Tatyana Betova2ORCID logo, Krasimir Petrov2ORCID logo, Savelina Popovska2ORCID logo,
1) Department of Obstetrics and Gynecology, Medical University - Pleven, Bulgaria.
2) Department of Pathoanatomy, Medical University - Pleven, Bulgaria.

Purpose: Caesarean section (C.S.) is the most commonly performed operative procedure of the uterus in women of reproductive age. Each of these women increases their likelihood of complications in subsequent pregnancies. There is an obsolete law in obstetrics: once a cesarean, always a cesarean, due to the danger of failure of the uterine scar tissue and the greatly increased possibility of uterine rupture. This necessitates the application of various methods of assessing the sufficiency of the scar tissue before planning further deliveries. The most accurate methods for determining the structure of a tissue are histological, which by their nature can not be used during the pregnancy but they can correlate to clinical ones.
Materials/ Methods: Prospective study of 40 pregnant women with previous C.S., divided into groups according to the interval between the operations. Another subsequent division of subgroups to the number of Caesarean sections was made. The morphological indicators were compared to a control group of dermal scar from the same patients. The results of the clinical methods were to be compared with the results of the same patients from the morphological studies. We used clinical methods such as the history of the previous pregnancies and puerperal period, history of previous operations and the recovery after them, ultrasound examination and evaluation of the anterior uterine wall preoperatively.  The morphological methods used are: Hematoxylin & eosin staining (H&E), followed by Masson Trichrome for collagen; Weigert-Van Gieson staining for elasticity; staining of immunohistochemistry MIB-1 (Ki-67) for cell proliferation.
Results: The study group was presented by patients with one or more previous C.S. that were divided in subgroups. The shortest inter-delivery interval was 14 months, the longest – 19 years. The shorter the period between the C.S.s was, the thinner the myometrium. Cases of abnormal healing have been observed, including: myometrial hyperplasia, adenomyosis, myofiber disarray, elastosis, inflammation, fibroids, keloids. These results can be compared to clinical data from patients but mainly with the number of previous C.S. or those with a brief period between them.
Conclusions: The results from our research proved that multiple C.S. is risk factors for larger defects of the uterine scar but not mandatory. The likelihood of prolonged healing time was higher in cases of more than one C.S. The dimensions of the surgical incision are associated with clinical symptoms such as postmenstrual smears, dysmenorrhoea and chronic pelvic pain.

Keywords: uterine rupture, caesarean section scar tissue, vaginal birth after previous caesarean section, uterine dehiscence,

pdf - Download FULL TEXT /PDF 2678 KB/
Please cite this article as: Gyokova E, PopovY, Ivanova-Yoncheva Y, Georgiev A, Dimitrova M, Betova T, Petrov K, Popovska S. Clinical-morphological evaluation of the quality of the uterine scar tissue after caesarean section. J of IMAB. 2019 Jan-Mar;25(1):2433-2437. DOI: 10.5272/jimab.2019251.2433

Corresponding AutorCorrespondence to: Elitsa Gyokova, Department of Obstetrics and Gynecology, Faculty of Medicine, Medical University – Pleven; 1, Kliment Ohridski Str., 5800 Pleven, Bulgaria; E-mail: egyokova@yahoo.com

1. Ofir K, Sheiner E, Levy A, Katz M, Mazor M. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol. 2003 Oct;189(4):1042-6.  [PubMed] [Crossref]
2. Turner MJ, Agnew G, Langan H. Uterine rupture and labour after a previous low transverse caesarean section. BJOG. 2006 Jun;113(6):729-32. [PubMed] [Crossref]
3. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004 Dec 16;351(25):2581-9. [PubMed] [Crossref]
4. National Institute for Health and Clinical Excellence. Caesarean section. NICE clinical guideline 132. Manchester: NICE; 2011
5. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010 Aug;116(2 Pt 1):450-63. [PubMed] [Crossref]
6. Cunningham FG, Bangdiwala SI, Brown SS, Dean TM, Frederiksen M, Rowland Hogue CJ, et al. NIH consensus development conference draft statement on vaginal birth after cesarean: new insights. NIH Consens State Sci Statements. 2010 Mar 10;27(3):1-42. [PubMed]
7. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu R, et al. Vaginal Birth After Cesarean: New Insights. Evid Rep Technol Assess (Full Rep). 2010 Mar;(191):1-397. [PubMed]
8. Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No. 45. London: RCOG; 2007. 5p.
9. Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No. 45. London: RCOG; 2015. 7p.
10. Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med. 2012; 9(3):e1001184. [PubMed] [Crossref]
11. Dekker GA, Chan A, Luke CG, Priest K, Riley M, Halliday J, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG. 2010 Oct;117(11):1358-65. [PubMed] [Crossref]
12. Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG. 2009 Jul;116(8):1069-78. [PubMed] [Crossref]
13. Barger MK, Weiss J, Nannini A, Werler M, Heeren T, Stubblefield PG. Risk factors for uterine rupture among women who attempt a vaginal birth after a previous cesarean: a case-control study. J Reprod Med. 2011 Jul-Aug;56(7-8):313-20. [PubMed]
14. Weimar CH, Lim AC, Bots ML, Bruinse HW, Kwee A. Risk factors for uterine rupture during a vaginal birth after one previous caesarean section: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2010 Jul;151(1):41-5. [PubMed] [Crossref]
15. Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 mo1nths. Obstet Gynecol. 2010 May;115(5):1003-6. [PubMed] [Crossref]
16. Bergeron ME, Jastrow N, Brassard N, Paris G, Bujold E. Sonography of lower uterine segment thickness and prediction of uterine rupture. Obstet Gynecol. 2009 Feb;113(2 Pt 2):520-2. [PubMed] [Crossref]
17. Kessous R, Sheiner E. Is there an association between short interval from previous cesarean section and adverse obstetric and perinatal outcome? J Matern Fetal Neonatal Med. 2013 Jul;26(10):1003-6. [PubMed] [Crossref]
18. Kok N, Wiersma IC, Opmeer BC, de Graaf IM, Mol BW, Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a metaanalysis. Ultrasound Obstet Gynecol. 2013 Aug;42(2):132-9. [PubMed] [Crossref]

Received: 27 October 2018
Published online: 21 March 2019

back to Online Journal