Experience of metroplasty in the second trimester in women with incompetent uterine scar
Background: The pregnancy rate in patients with incompetent uterine scar (isthmocele) ranges between 1/1800 and 1/2216, which makes up 6.1% of all pregnancies with a history of cesarean section. Isthmocele occurs in 70% of pregnant women who previously underwent uterine surgery and presents a high risk of uterine rupture. Metroplasty during pregnancy is a rare type of medical care that requires profound knowledge and experience in this area.Sukhanov A.A., Legalova T.V., Obryadov M.A., Dikke G.B., Kukarskaya I.I.
Case report: The article presents a clinical observation of a 33-year-old patient with a uterine scar in her second pregnancy after having a cesarean section 6 years before. The routine ultrasound examination revealed a 28.0×16.0×40.0 mm isthmocele at 19–20 weeks’ gestation, clinical symptoms were absent. After the patient was hospitalized, metroplasty was performed. The pregnancy was prolonged to 34 weeks due to the administered medications for the prevention of preterm birth. The thickness of the myometrium in the area of the scar was 2.0 mm. When there were complaints indicating the threat of the uterine rupture (pain in the lower abdomen, a decrease in the thickness of the myometrium to 1.8 mm), a cesarean section was performed. A live premature female infant was born weighing 1922 g, 47 cm long, with an Apgar score of 7–8 points. The wound on the uterus was closed with a double-row continuous polyglycolide suture, peritonization was not performed. The postoperative period was uneventful. The patient was discharged on the 3rd day after the operation. After 6 months, the ultrasound examination showed that the endometrium corresponded to the first phase of the cycle, the uterine scar along the anterior wall had no signs of incompetence and was more than 10 mm thick. The child’s development was age-appropriate.
Conclusion: Metroplasty for the incompetent uterine scar is a method of choice that makes possible to prolong a pregnancy and deliver a viable child at the time close to full-term.
Authors’ contributions: Sukhanov A.A. – the analysis of the obtained data, writing the first version of the text of the article; Legalova T.V., Obryadov M.A. – collecting the clinical data, reviewing publications on the issue; Dikke G.B. – the analysis of literary sources, editing the first version of the article; Kukarskaya I.I. – developing the design of the study, organization of the research, guidance during the study.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was not sponsored.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Sukhanov A.A., Legalova T.V., Obryadov M.A.,Dikke G.B., Kukarskaya I.I. Experience of metroplasty in the second trimester in women with incompetent uterine scar.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (9): 200-206 (in Russian)
https://dx.doi.org/10.18565/aig.2023.213
Keywords
metroplasty
incompetent uterine scar
isthmocele
prolongation of pregnancy
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Received 04.09.2023
Accepted 10.09.2023
About the Authors
Anton A. Sukhanov, PhD, Head of the Department of Gynecology, Perinatal Center, 625002, Russia, Tyumen, Daudelnaya str., 1; Associate Professor, Department of Obstetrics and Gynecology, Institute of Maternity and Childhood, Tyumen State Medical University, Ministry of Health of Russia, 625023, Russia, Tyumen, Odesskaya str., 54, such-anton@yandex.ru, https://orcid.org/0000-0001-9092-9136Tatyana V. Legalova, PhD, Deputy Chief Physician for Medical Part, Perinatal Center, 625002, Russia, Tyumen, Daudelnaya str., 1.
Mikhail A. Obryadov, student of the Pediatric Faculty, Tyumen State Medical University, Ministry of Health of Russia, 625023, Russia, Tyumen, Odesskaya str., 54,
https://orcid.org/0009-0009-8518-1800
Galina B. Dikke, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology with a course of reproductive medicine, F.I. Inozemtsev Academy of Medical Education, 190013, Russia, St. Petersburg, Moskovsky Prospect, 22 liter M, galadikke@yandex.ru, https://orcid.org/0000-0001-9524-8962
Irina I. Kukarskaya, Dr. Med. Sci., Associate Professor, Head of the Department of Obstetrics, Gynecology and Perinatology, Institute of Maternity and Childhood,
Tyumen State Medical University, Ministry of Health of Russia, 625023, Tyumen, Odesskaya str., 54; Chief Physician, Perinatal Center, 625002, Russia, Tyumen,
Daudelnaya str., 1; Chief Specialist in Obstetrics and Gynecology, Department of Health of the Tyumen Region, https://orcid.org/0000-0002-8275-3553
Corresponding author: Anton A. Sukhanov, such-anton@yandex.ru
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