Pregnancy prolongation during uterine scar dehiscence after caesarean section
Background: The incidence of uterine scar dehiscence amounts to about 0.2—4.5% and carries the risks of transitionto uterine rupture. The data onthe frequency of ruptures are different, which is associatedwith the inaccuracy of the terminology, with the fact what is included in the concept of “uterine scar rupture” and “scar dehiscence”. This necessitates a search for new approaches to managing patients with this complication, including innovative ones that allow not only to preserve the uterus, but also to prolong pregnancy in order to improve perinatal outcomes.Savina L.V., Yashchuk A.G., Gurova Z.G., Arkhipov V.V., Savin A.M., Maslennikov A.V.
Case report: The paper presents experience in managing patients with uterine scar dehiscence after cesarean section in the second trimester ofpregnancy with the clinical presentations of incomplete (non-penetrating) uterine scar rupture. In all three described cases, metroplasty followed by pregnancy prolongation could be performed. Conclusion: Metroplasty during the current pregnancy could prolong pregnancies that ended in the birth of viable babies.
Keywords
caesarean section
uterine scar dehiscence
metroplasty
References
1. Айламазян Э.К., Кулаков В.И., Радзинский В.Е., Савельева Г.М., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2014. 1200с. [Ajlamazyan E.K., Kulakov V.I., Radzinskij V.E., Savelyeva G.M. Obstetrics: National Guide. M.: GEOTAR-Media; 2011. 1200 p. (in Russian)].
2. Кулаков В.И., Манухин И.Б., Савельева Г.М., ред. Гинекология. Национальное руководство. М.: ГЭОТАР-Медиа; 2007. 1072с. [Kulakov V.I., Manukhin I.B., Savelyeva G.M. Gynecology: National Guide. M.: GEOTAR-Mediat; 2007. 1072 p. (in Russian)].
3. Кулаков В.И., Чернуха Е.А., Комиссарова Л.М. Кесарево сечение. М.: Триада-Х; 2004. 160с. [Kulakov V.I., Chernukha E.A., Komissarova L.M. Cesarean section. M.; 2004. 160 p. (in Russian)].
4. Chilaka V.N., Cole M.Y., Habayeb O.X., Konje J.C. Risk of uterine rupture following induction of labour in women with a previous caesarean section in a large UK teaching hospital. J. Obstet. Gynaecol. 2004; 24(3): 264-5. https://dx.doi.org/10.1080/01443610410001660751.
5. Шмидт А.А., Тимофеева Н.Б., Соломко Д.В., Гайворонских Д.И., Егорова А.А. Пролонгированные беременности у женщины с разрывом матки по рубцу. StatusPraesens. 2019: 1: 111-3. [Shmidt A.A., Timofeeva N.B., Solomko D.V., Gajvoronskikh D.I., Egorova A.A. Prolonged pregnancies in a woman with a ruptured uterus along the scar. StatusPraesens. 2019; 1(54): 111-3. (in Russian)].
6. Сафиуллин Р.И., Мусин И.И., Молоканова А.Р. «Медленное» кесарево сечение при несостоятельности корпорального рубца (клинический случай). Креативная хирургия и онкология. 2018; 8(2): 159-64. [Safiullin R.I., Musin I.I., Molokanova A.R. "Slow" cesarean section with corporal scar failure (clinical case). Kreativnaja hirurgija i onkologija/ Creative surgery and oncology. 2018; 8(2): 159-164. (in Russian)].
7. Логутова Л.С., Гаспарян Н.Д., Ахвледиани К.Н. Критерии диагностики состояния рубца на матке после кесарева сечения. В кн.: IV Российский форум «Мать и Дитя»: Тезисы докладов. М.; 2017: 376-7. [Logutova L.S., Gasparyan N.D., Akhvlediani K.N. Criteria for diagnosing the condition of the uterine scar after cesarean section. IV Russian Forum "Mother and Child": Abstracts. M.: 2017. 376-7. (in Russian)].
8. Savukyne E., Bykovaite-Stankeviciene R., Machtejeviene E., Nadisauskiene R., Maciuleviciene R. Symptomatic uterine rupture: a fifteen year review. Medicina (Kaunas). 2020; 56(11): 574. https://dx.doi.org/10.3390/ medicina56110574.
9. Sanchez-Ramos L., Kaunitz A.M., Peterson H.B., Martinez-Schnell B., Thompson R.J. Reducing cesarean section rates at a teaching hospital. Am. J. Obstet. Gynecol. 1990; 163(3): 1081-7; discussion 1087-8. https://dx.doi.org/10.1016/0002-9378(90)91132-v.
10. Ibrahim S., Drymiotou S., Hegab K., Sideris M., Okba M. Second trimester rupture uterus, unusual presentation. Ann. Med. Surg. (Lond.). 2020; 61: 145-7. https://dx.doi.org/10.1016/j.amsu.2020.12.020.
11. Стрижаков А.Н., Кузьмина Т.Е. Беременность после кесарева сечения: течение, осложнения, исходы. Вопросы гинекологии, акушерства и перинатологии. 2017; 1(2): 40-6. [Strizhakov A.N., Kuzmina T.E. Pregnancy after cesarean section: course, complications, outcomes. Questions of gynecology, obstetrics and perinatology. 2017; 1(2): 40-6. (in Russian)].
12. You S.H., Chang Y.L., Yen C.F. Rupture of the scarred and unscarred gravid uterus: outcomes and risk factors analysis. Taiwan. J. Obstet. Gynecol. 2018; 57(2): 248-54. https://dx.doi.org/10.1016/j. tjog.2018.02.014.
13. Wing D.A., Paul R.H. Vaginal birth after cesarean section: selection and management. Clin. Obstet. Gynecol. 1999; 42(4): 836-48. https://dx.doi.org/10.1097/00003081-199912000-00010.
14. Abdelazim I.A., Shikanova S., Kanshaiym S., Karimova B., Sarsembayev M., Starchenko T. Cesarean section scar dehiscence during pregnancy: Case reports. J. Family Med. Prim. Care. 2018; 7(6): 1561-5. https://dx.doi.org/10.4103/ jfmpc.jfmpc_361_18.
15. Sawada M., Matsuzaki S., Nakae R., Iwamiya T., Kakiga-no A., Kumasawa K. et al. Treatment and repair of uterine scar dehiscence during cesarean section. Clin. Case Rep. 2017; 5(2): 145-9. https://dx.doi.org/10.1002/ ccr3.766.
16. Савельева Г.М., Курцер М.А., Бреслав И.Ю., Караганова Е.Я., Неклюдова Ю.В. Непроникающий разрыв матки по рубцу после кесарева сечения и расползание/аневризма рубца на матке во второй половине беременности и в родах. Акушерство и гинекология. 2021; 6: 66-72. [Savelyeva G.M., Kurtser M.A., Breslav I.Yu. Karaganova E.Ya, Neklyudova Yu.V. Non-penetrating uterine rupture along the scar after cesarean section and dehiscence /aneurysm of the uterine scar in the second half of pregnancy and during childbirth. Obstetrics and Gynecology. 2021; 6: 60-72 (in Russian)]. https://dx.doi.org/10.18565/ aig.2021.6.66-72.
17. Жаркин Н.А., Баринов С.В., Логутова Л.С., Биндюк А.В., Мирошников А.Е., Шевцова Е.П., Семихова Т.Г. Беременность и роды у женщин с оперированной маткой: монография. М.; 2020. 102с. [Zharkin N.A.,
Barinov S.V., Logutova L.S., Bindyuk A.V., Miroshnikov A.E., Shevtsova E.P., Semikhova T.G. Pregnancy and childbirth in women with an operated uterus: a monograph. М.; 2020. 120 p. (in Russian)].
18. Жаркин Н.А., Прохватилов С.А., Бурова Н.А., Гаврильчук Т.К., Грамматикова О.А., Мудрая Е.В., Снигур Г.Л. Хирургическая реконструкция рубца на матке во время беременности. Показания, условия и риски. Акушерство и гинекология. 2018; 10: 142-7. [Zharkin N.A., Prokhvatilov S.A., Burova N.A., Gavrilchuk T.K., Grammatikova O.A., Mudraya E.V., Snigur G.L. Surgical repair of uterine scar during pregnancy: indication, conditions, and riskc. Obstetrics and Gynecology. 2018; 10: 142-7. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.10.142-147.
Received 11.11.2021
Accepted 30.12.2021
About the Authors
Liana V. Savina, postgraduate student of the Department of Obstetrics and Gynecology, Bashkir State Medical University, Ministry of Health of Russia; Deputy Chief Medical Officer of Maternity Hospital No. 3, +7(937)835-73-93, Anika-cor@mail.ru, 450000, Russia, Ufa, Koltsevaya str., 131.Alfiya G. Yashchuk, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Bashkir State Medical University, Ministry of Health of Russia, 450000, Russia, Ufa, Lenin str., 3.
Zukhra G. Gurova, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Bashkir State Medical University, Ministry of Health of Russia;
Chief Physician, Maternity Hospital No. 3, 450000, Russia, Ufa, Koltsevaya str., 131.
Albert M. Savin, obstetrician-gynecologist, Head of the Maternity Department, Maternity Hospital No. 3, 450000, Russia, Ufa, Koltsevaya str., 131.
Vladimir V. Arkhipov, PhD, obstetrician-gynecologist, Department of Obstetrics, Maternity Hospital No. 3, 450000, Russia, Ufa, Koltsevaya str., 131.
Anton V. Maslennikov, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Associate Professor at the Department of Anatomy, Bashkir State Medical University, Ministry of Health of Russia, 450000, Russia, Ufa, Lenin str., 3.
Corresponding author: Liana V. Savina, Anika-cor@mail.ru
Authors’ contributions: Savina L.V., Savin A.M., Arkhipov V.V - follow-up, surgical intervention, writing the article;
Yashchuk A.G., Gurova Z.G. - follow-up, design of the investigation, final editing of the article; Maslennikov A.V - final editing of the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: There has been no finding for this investigation.
Ethical Approval: The investigation has been approved by the local Ethics Committee of the Bashkir State Medical University, Ministry of Health of the Russian Federation.
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
For citation: Savina L.V., Yashchuk A.G., Gurova Z.G., Arkhipov V.V., Savin A.M.,
Maslennikov A.V. Pregnancy prolongation during uterine scar dehiscence after caesarean section.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 3: 148-154 (in Russian)
https://dx.doi.org/10.18565/aig.2022.3.148-154
Similar Articles
