Standardized examination of postoperative uterine scar

DOI

https://dx.doi.org/10.18565/aig.2022.1.42-47

Gus A.I., Yarygina T.A., Mikheeva A.A., Voеvodina V.I., Shmakov R.G.
1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia 2) A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia

This publication reviews the international guidelines approved in 2019 on the standards for ultrasound, examination of the postoperative uterine scar, by taking into account the Delphi system for harmonizing the opinions of leading world experts. The importance of unifying the methodology of an investigation and the terminology for describing the ultrasound image is due to the global trend of an increase in the rate of cesarean section and related postoperative and long¬term complications. Numerous studies of myometrial scar defect at cesarean section have confirmed its role in the development of abnormal uterine bleeding, dysmenorrhea, and complications in subsequent pregnancies, including scar ectopic pregnancy and abnormal placental invasion. In turn, organ-sparing surgeries for placenta increta lead to an increase in the number of patients with multiple areas of myometrial cicatricial changes, the long-term consequences of which have not yet been studied.
This publication describes in detail the methodological aspects of both the standard ultrasound examination and echo contrast technology and sets out the definitions and concepts of echographic criteria to define the niche, the thickness of the residual and adjacent myometrium. It presents the sampling protocol for transvaginal ultrasound examination of a postoperative scar area, which can be used for all groups of patients who have undergone cesarean section, including cases of organ-sparing surgeries for placenta increta.
Conclusion: The daily clinical introduction of a standardized approach to assessing the postoperative uterine scar and describing pathological changes in its area will be able to reach interdisciplinary and clinical consensus, to expand the possibilities of monitoring ongoing studies, to obtain evidence-based information on the correlation of ultrasound and clinical patterns, thereby contributing to improving the quality of medical care.

cesarean section

uterine scar

niche

myometrial defect

ultrasound examination

protocol

Full text (in Russian)

Nagy S, Papp Z. Global approach of the cesarean section rates. Perinat. Med. 2020; 49(1): /1-4. https://dx.doi.org/10.1515/jpm-2020-0463.
Blondon M., Casini A., Hoppe K.K., Boehlen F, Righini M., Smith N.L. Risks of venous thromboembolism after cesarean sections: a meta-analysis. 2016; 150(3): 572-96. https://dx.doi.org/10.1016/j.chest.2016.05.021.
de la Cruz C.Z., Thompson E.L., O’Rourke K., Nembhard W.N. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Gynecol. Obstet. 2015; 292(6): 1201-15. https://dx.doi.org/10.1007/s00404-015-3790-2.
Sheikh M.S., Nelson G., Wood S.L., Metcalfe A. Surgical errors and complications following cesarean delivery in the United States. J. Obstet. Gynecol. MFM. 2020; 2(1): 100071. https://dx.doi.org/10.1016/j.ajogmf.2019.100071.
Keag O.E., Norman J.E., Stock S.J. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018; 15(1): e1002494. https://dx.doi.org/10.1371/journal.pmed.1002494.
Кабатин Н.А., Калинин В.В., Щерина А.В., Полонецкий А.Я., Смирнов А.В. Синдром Огилви как редкое хирургическое осложнение после операции кесарева сечения. Акушерство и гинекология. 2021; 5: 199-203. [Kabatin N.A., Kalinin V.V., Shcherina A.V., Polonetsky A.Ya., Smirnov A.V. Ogilvie’s syndrome as a rare surgical complication after cesarean section. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 5: 199-203. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.5.199-203.
Kainu J.P., Halmesmaki E., Korttila K.T., Sarvela P.J. Persistent pain after cesarean delivery and vaginal delivery: a prospective cohort study. Analg. 2016; 123(6): 1535-45. https://dx.doi.org/10.1213/ANE.0000000000001619.
Малышева А.А., Матухин В.И., Рухляда Н.Н., Тайц А.Н., Новицкая Н.Ю. Истонченный рубец на матке после кесарева сечения: оценка факторов риска. Акушерство и гинекология. 2021; 2: 77-83. [Malysheva A.A., Matukhin V.I., Rukhlyada N.N., Taits A.N., Novitskaya N.Yu. Risk factors for cesarean uterine scar defect. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 2: 77-83 (in Russian)]. https://dx.doi.org/10.18565/2021.2.77-83.
Glavind J., Madsen L.D., Uldbjerg N., Dueholm M. Cesarean section scar measurements in non-pregnant women using three-dimensional ultrasound: a repeatability study. J. Obstet. Gynecol. Reprod. Biol. 2016; 201: 65-9. https://dx.doi.org/10.1016/j.ejogrb.2016.03.019.
Baranov A., Gunnarsson G., Salvesen K.A., Isberg PE., Vikhareva O. Assessment of Cesarean hysterotomy scar in non-pregnant women: reliability of transvaginal sonography with and without contrast enhancement. Ultrasound Obstet. Gynecol. 2016; 47(4): 499-505. https://dx.doi.org/10.1002/uog.14833.
Fiocchi F., Petrella E., Nocetti L., Curra S., Ligabue G., Costi T. et al. Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging. Radiol. Med. 2015; 120(2): 228-38. https://dx.doi.org/10.1007/ s11547-014-0431-y.
van der Voet L.L.F., Limperg T., Veersema S., Timmermans A., Bij de Vaate A.M.J., Brolmann H.A.M., Huirne J.A.F. Niches after cesarean section in a population seeking hysteroscopic sterilization. J. Obstet. Gynecol. Reprod. Biol. 2017; 214: 104-8. https://dx.doi.org/10.1016/j.ejogrb.2017.05.004.
Alalfy M., Osman O.M., Salama S., Lasheen Y., Soliman M., Fikry M. et al. Evaluation of the cesarean scar niche in women with secondary infertility undergoing ICSI using 2D sonohysterography versus 3D sonohysterography and setting a standard criteria; alalfy simple rules for scar assessment by ultrasound to prevent health problems for women. Int. J. Womens Health. 2020; 12: 965-74. https://dx.doi.org/10.2147/IJWH.S267691.
Zhou X., Zhang T., Qiao H., Zhang Y., Wang X. Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section. BMC Womens Health. 2021; 21(1): 199. https://dx.doi.org/10.1186/ s12905- 021-01337-x.
Коган О.М., Войтенко Н.Б., ЗосимоваЕ.А., Мартынова Э.Н., Нерсесян Д.М., Бубникович А.А. Алгоритм ведения пациенток с несостоятельностью послеоперационного рубца на матке после кесарева сечения. Клиническая практика. 2018; 9(3): 38-43. [Kogan O.M., Voytenko N.B., Zosimova E.A., Martynova E.N., Nersesyan D.M., Bubnikovich A.A. Algorithm for the management of patients with incompetence of postoperative uterine scar after cesarian section, our clinical experience. Clinical practice. 2018; 9(3): 38-43. (in Russian)].
De Mucio B., Serruya S., Aleman A., Castellano G., Sosa C.G. A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. J. Gynaecol. Obstet. 2019; 147(3): 281-91. https://dx.doi.org/10.1002/ijgo.12948.
Земскова Н.Ю., Чечнева М.А., Петрухин В.А., Лукашенко С.Ю. Ультразвуковое исследование рубца на матке после кесарева сечения в прогнозе исхода беременности. Акушерство и гинекология. 2020; 10: 99-104. [Zemskova N.Yu., Chechneva M.A., Petrukhin V.A., Lukashenko S. Yu. Ultrasound examination of the cesarean scar in the prognosis of pregnancy outcome. Akusherstvo i Ginekologiya / Obstetrics and gynecology. 2020; 10: 99-104 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.99-104.
Гус А.И., Бойкова Ю.В., Ярыгина Т.А., Яроцкая Е.Л. Современные подходы к пренатальной диагностике и скринингу врастания плаценты (обзор рекомендаций). Акушерство и гинекология. 2020; 10: 5-12. [Gus. A.I., Boykova Yu.V., Yarygina T.A., Yarotskaya E.L. Modern approaches to prenatal diagnosis and screening of placenta accreta (Review of Recommendations) Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 10: 5-12 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.5-12.
Шмаков Р.Г., Пирогова М.М., Васильченко О.Н., Чупрынин В.Д., Пырегов А.В., Ходжаева З.С., Клименченко Н.И., Федорова Т.А., Ежова Л.С., Быченко В.Г., Бойкова Ю.В. Органосохраняющие операции при аномальной инвазии плаценты (5-летний опыт Национального медицинского исследовательского центра акушерства, гинекологии и перинатологии имени академика В.И. Кулакова). Доктор.Ру. 2019; 11: 29-34. [Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Pyregov A.V., Khodzhaeva Z.S., Klimenchenko N.I., Fedorova T.A., Ezhova L.S., Bychenko V.G., Boykova Yu.V. Organ-preserving operations in case of abnormal invasion of the placenta (5-year experience of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov). Doctor.Ru. 2019; 11(166): 29-34. (in Russian)]. https://dx.doi.org/10.31550 / 1727-2378-2019-166-11-29-34.
Курцер М.А., Бреслав И.Ю., Григорьян А.М., Латышкевич О.А., Кутакова Ю.Ю., Кондратьева М.А. Временная баллонная окклюзия общих подвздошных артерий при осуществлении органосохраняющих операций у пациенток с врастанием плаценты. Акушерство и гинекология: новости, мнения, обучение. 2018; 6(4): 31-7. [Kurzer M.A., Breslav I.Yu., Grigoryan A.M., Latyshkevich O.A., Kutakova Yu.Yu., Kondratieva M.A. Temporary balloon occlusion of the common iliac arteries during organ-preserving operations in patients with placenta accrete. Obstetrics and gynecology: news, opinions, training. 2018; 6(4): 31-7. (in Russian)].
Шмаков Р.Г., Пирогова М.М., Васильченко О.Н., Чупрынин В.Д., Ежова Л.С. Хирургическая тактика при врастании плаценты с различной глубиной инвазии. Акушерство и гинекология. 2020; 1: 78-82. https://dx.doi.org/10.18565/aig.2020.1. [Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Ezhova L.S. Surgical tactics for ingrowth of the placenta with different depths of invasion. Obstetrics and gynecology. 2020; 1: 78-82. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1.
Мартынов С.А., Адамян Л.В. Рубец на матке после кесарева сечения: терминологические аспекты. Гинекология. 2020; 22(5): 70-5. [Martynov S.A., Adamyan L.V. Cesarean scar defect: terminological aspects. 2020; 22(5): 70-5. (in Russian)]. https://dx.doi.org/10.26442/ 20795696.2020.5.200415.
van der Voet L.F., Jordans I.P.M., Brolmann H.A.M., Veersema S., Huirne J.A.F. Changes in the uterine scar during the first year after a Caesarean section: a prospective longitudinal study. Obstet. Invest. 2018; 83(2): 164-70. https://dx.doi.org/10.1159/000478046.
Jordans I.P.M., De Leeuw R.A., Stegwee S.I., Amso N.N., Barri- Soldevila PN., Van Den Bosch T., Huirne J.A.F. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet. Gynecol. 2019; 53(1): 107-15. https://dx.doi.org/10.1002/uog.19049.
Макиян З.Н., Адамян Л.В., Карабач В.В., Чупрынин В.Д. Новый метод хирургического лечения несостоятельности рубца на матке после кесарева сечения с помощью внутриматочного манипулятора с желобом. Акушерство и гинекология. 2020; 2: 104-10. [Makiyan Z.N., Adamyan L.V., Karabach V.V., Chuprynin V.D. A new method for surgical treatment of uterine scar insuffisiency after a previous cesarean section using an intrauterine manipulator with a groove. Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 2: 104-10. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.2.104-110.
Naji O., Abdallah Y., Bij De Vaate A.J., Smith A., Pexsters A., Stalder C. et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet. Gynecol. 2012; 39(3): 252-9. https://dx.doi.org/10.1002/uog.10077.
Hsu C., Sandford B.A. The Delphi technique: making sense of consensus. PARE: Practical Assessment, Research and Evaluation. 2007; 12(10): 1-8. https://dx.doi.org/10.7275/pdz9-th90.

Received 15.11.2021

Accepted 01.12.2021

Alexandr I. Gus, Dr. Med. Sci., Professor, Chief Researcher of Ultrasound and Functional Diagnostics Department, Radiology Division, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, a_gus@oparina4.ru, https://orcid.org/0000-0003-1377-3128, 117997, Russia, Moscow, Oparina str., 4.
Tamara A. Yarygina, MD, PhD, Specialist of Ultrasound Diagnostics, Perinatal Cardiology Center, Researcher, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, +7(495)414-78-75, tamarayarygina@gmail.com, https://orcid.org/0000-0001-6140-1930, 121552, Russia, Moscow, Roublyevskoe Shosse, 135.
Alexandra A. Mikheeva, PhD Student, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495) 438-30-47, shuratora@mail.ru, https://orcid.org/0000-0002-8159-6373, 117997, Russia, Moscow, Oparina street, 4.
Vlada I. Voevodina, PhD Student, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(495)438-30-47, vladavoevodina@yandex.ru, https://orcid.org/0000-0001-9395-5719, 117997, Russia, Moscow, Oparina str., 4.
Roman G. Shmakov, Dr. Med. Sci., Professor, Director of Institute of Obstetrics, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia; Chief Freelance Specialist in Obstetrics of the Ministry of Health of the Russian Federation, +7(495)438-72-00, r_shmakov@oparina4.ru, https://orcid.org/0000-0002-2206-1002, 117997, Russia, Moscow, Oparina str., 4.

Authors’ contributions: Yarygina T.A., Shmakov R.G., Gus A.I. - concept and design of the investigation; Mikheeva A.A., Yarygina T.A., Voevodina V.I. - writing the text; Mikheeva A.A., Yarygina T.A., Voеvodina V.I. - material collection and processing; Shmakov R.G., Gus A.I. - editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has been conducted without additional funding.
For citation: Gus A.I., Yarygina T.A., Mishieva N.G., Voevodina V.I., Shmakov R. G. Standardized examination of postoperative uterine scar.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 1:42-47(in Russian)
https://dx.doi.org/10.18565/aig.2022.1.42-47

Standardized examination of postoperative uterine scar

Gus A.I., Yarygina T.A., Mikheeva A.A., Voеvodina V.I., Shmakov R.G.

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