Mishchenko V. P., Mishchenko V. V.

THE PROBLEM OF THE "OPERATED UTERUS" IN MODERN CLINICAL PRACTICE (LITERATURE REVIEW)

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About the author:

Mishchenko V. P., Mishchenko V. V.

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LITERATURE REVIEWS

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Scientific article

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The problem of the "operated uterus" in modern clinical practice is the occurrence of uterine scar failure, the frequency of which, according to various authors, ranges from 19% to 84%. Complications of anatomical and functional failure of the uterine tissues before and during pregnancy explain the clinical need for an in-depth study of this issue. Prevention of uterine wound healing defects after surgery begins before pregnancy planning and directly during surgery. The issues preventing uterine wound healing defects, including medical treatment, are actively discussed. Clinically, it is important to assess the initial state of a woman's body, especially if she has a scar(s) on the uterus after previous surgical procedures. During a repeat caesarean section, a defect (complete or partial) of the uterine scar is often diagnosed, which may be the cause of technical difficulties in restoring the integrity of the uterine wall. Full restoration of the uterine wall in the area of incision/trauma prevents defects. It is essential to define the stages of such operations and prevent additional uterine tissue ruptures and ruptures of adjacent organs. The technique of surgery for uterine rupture after hysteroscopy and conservative myomectomy has its peculiarities. Identification of clinical and instrumental signs of an "operated uterus" before pregnancy makes it possible to determine and implement personalised not only preventive/therapeutic measures, but also a likely safe period for pregnancy planning and features of gestational periods by trimesters, the timing and method of labour.

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1. Risager JK, Uldjerg N, Clavind J. Cesarean scar thickness in non–pregnant women as a risk factor for uterine rupture. The Journal of Maternal–Fetal & Neonatal Medicine. 2022;35:389-394. DOI: 10.1080/146058.2020.119065.
2. Barger BT, Brar H, Oshiro B, Smithson S. Third trimester asymptomatic uterine rupture with ballooning of fetal membranes, case report. Research square. 2024. DOI: https://doi.org/10.21203/rs.3.rs–4254492/v1.
3. Debra E, Capmas P, Maudor C, Chavatt–Palmer P. Uterine wound healing after caesarean section: A systematic review. European Journal of Obstetrics Gynecology and Reproductive Biology. 2024;296:83-90. DOI: .
4. Moritti L, Stalfort I, Barker TH, Abebayehu D. The interplag of fibroblasts, the extracellular matrix, and inflammation in scar formation. J Biol Chem. 2022;298(2):101530.
5. Balalau OD, Bacalbasa N, Balalau C, Negrei C, Galatewanu B, Ghinghina O, et al. The correlation between histopathological and ultrasound findings regarding Cesarean section scar: a three–year survey study. J Mind Med Sci. 2019;6(1):141-149.
6. Ministerstvo okhorony zdorovʼya Ukrayiny. Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy «Kesariv roztyn». Kyyiv: MOZ Ukrayiny; 2021. 37 s. [in Ukrainian].
7. Agarwal SK, Chapron C, Giudice LC, Laufer MR. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Cynecol. 2019;220:e351-e354.
8. Zhelezov DM, Savenko TO. Formuvannya rubtsya na mattsi ta ekspresiya spetsyfichnykh bilkiv spoluchnoyi tkanyny. Akusherstvo ta hinekolohiya. 2020;1:132-136. DOI: https://doi.org/10.11603/24116–4944.2020.1.11498. [in Ukrainian].
9. Chen YY, Tsai CC, Kung F-T, Lan K-Ch, Ou Y-Ch. Association between hysteroscopic findings of previous cesarean delivery scar defects and abnormal uterine bleeding. Taiwar. J Obstet Gynecol. 2019;458:541-544. DOI: 10.1016/j.tjog.2019.05.020.
10. Gkegkes ID, Psomiadou V, Minis E, Iavazzo C. Robot–assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence. J Robot Surg. 2022;16(6):138-142.
11. Doselda E, Gal P, Calda P. Association between deficient cesarean delivery scar and cesarean scar syndrome. J Clin Ultrasound. 2020;48(9):513-584.
12. Donnez O. Cesarean scar disorder: Management and repair. Best Practice Research Clinical Obstetrics Gynaecology. 2023;90:102398. DOI: https://doi.org/10/1016/J/bpobgyn.2023.102398.
13. Wei H, Dan F, Jianru L. Clinical analysis of scarred uterus patients with uterine rupture during pregnancy. Chin J Obstet Gynecol Pediatr (Electron Ed). 2020;6(4):423-429. DOI: 10.3877/cma.j.issn.1673–5250.2020.04.008.
14. Xia W, Wang X, Wang Y, Tian Y, He Ch, Zhu Ch, et al. Comparative effectiveness of transvaginal repair vs. hysteroscopic resection in patients with symptomatic uterine niche. Front Surg. 2023;10:1019237. DOI: 10.3389/fsurg.2023.1019237.
15. Glavind J, Forman A, Johansen MJ, Uldbjerg N, Hvidman L, Bor IP. Niche development after closure of caesarean uterotomy by conventional double–suture or modified single–suture technique (NICUM): A randomized trial. Reproductive, Female and Child Health. 2023;2(3):124–132. DOI: https://doi.org/10.1002/rfc2.39.
16. Jordans IM, Leeuw R, Stegwee SI, Amso N. A practical guideline for examining a uterine niche using ultrasonography in non–pregnant women: a modified Delphi method amongst European experts. Ultrasound Obstet Gynecol. 2019;53:107-115. DOI: 10.1002/uog.19049.
17. Huang L, Zhao L, Shi H. Clinical efficacy of combined hysteroscopic and laparoscopic surgery and reversible ligation of the uterine artery for excision and repair of uterine scar in patients with type II and III cesarean scar pregnancy. Med. Sci Monit. 2020;26:e924076. DOI: 10.12659/MSM.924076.
18. Vitale SG, Ludwin A, Vilos GA, Torok P, Tesarik J, Vitagliano A, et al. From Hysteroscopy to Laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-іnflysis. Arch Gynecol Obstet. 2020;301(1):33-52. DOI: 10.1007/s00404–020–05438–0.
19. Schnabel A, Bächer A-S, Endreß E, Leichtl S, Köninger A. Uterus rupture. Frauenheilkunde up2date. 2022;16(05):425-440. DOI: 10.1055/ a–1768–2472.
20. Kovyda NR, Honcharuk NP. Doslidzhennya perfuziyi sudyn matky pry nespromozhnosti rubtsya na mattsi pislya kesarevoho roztynu. Reproduktyvne zdorovya zhinky. 2020;5(45):21-23. DOI: https://doi.org/ 10.30841/2708–8731.5.2021.224488. [in Ukrainian].
21. Kyrychenko MM, Amro AT. Spromozhnistʹ/nespromozhnistʹ rubtsya na mattsi pislya operatsiyi kesariv roztyn. Zbirnyk tez dopovidey naukovo-praktychnoyi konferentsiyi z mizhnarodnoyu uchastyu molodykh vchenykh ta studentiv Aktualʹni pytannya suchasnoyi medytsyny i farmatsiyi; 2019 Trav 13-17; Zaporizhzhya. Zaporizhzhya: ZDMU; 2019. s. 59-60. Dostupno: htth://dspace.zsmu.edu.ua/ handle/123456789/9712. [in Ukrainian].
22. Scanes CG, Dridi S, editors. Sturkie’s Avian Physiology. 7th ed. London: Academic Press; 2022. Chapter 23, Skeletal muscle; p. 565-589. DOI: https://doi.org/10.1016/B978–0–12–819770–7.00024–4.
23. Meuleman SK, Muryi A, Van den Bosch Th, Donnez O. Definition and Criteria for Diagnosing Cesarean Scar Disorder. JAMA. 2023;6(3):e235321. DOI: 10.1001/iamanetworkopen.2023.5321.
24. Nezhat C, Grace L, Soleimannjad R, Razavi GM. Cesarean scar defect: what it and how should it be treated? Surgical Technigues. 2019;28(4):32-53.
25. Piersma B, Bank RA. Cоllagen cross-linking mediated by lysyl hydroxylase 2: an enzymatic battlefield to combat fibrosis. Essays in diochemistry. 2019;63(3):377-378. DOI: https://doi.org/10.1042/EBC20180051.
26. Peskova V, Kacerovsky M. Cesarean scar defect – manifestation, diagnostics, treatment. Ceska Gynecol. 2020;85(4):282-287.
27. Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramaticallv increased. Fertil Steril. 2020;113(4):704-716.
28. Ludwin F, Martins WP, Ludwin I. Evaluation of uterine niche by three-dimensional sonohysterography and volumentric guantification: technigues and scoring classification system. Ultrasound obstet Gynecol. 2019;53(1):139-143.
29. Chen H, Wang H, Zhou J, Xiong Y, Wang X. Vaginal repair of cesarean section scar diverticula diagnosed in nonpregnant women. J Minium Invasive Gynecol. 2019;26(3):526-534. DOI: 10.1016/j.mig.2019.06.012.
30. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382:1244-1256.
31. Ministerstvo okhorony zdorovʼya Ukrayiny. Nakaz MOZ №1730 Standarty medychnoyi dopomohy «Ektopichna vahitnistʹ». Kyyiv: MOZ Ukrayiny; 2022. 27 s. [in Ukrainian].
32. Nitahara K, Fujita Y, Magarifuchi N, Taniguchi S, Shmamoto T. Maternal characterіstics and neonatal outcomes of emergency repeat caesarean deliveries due to early-term spontaneous labour onset. Aust NZ J Obstet Gynaecol. 2021;61(1):48-54. DOI: 10.1111/ajo.13225.
33. Pan H, Zeng M, Xu T, Li D, Mol BWJ, Zhang J, et al. The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study. Acta Obstet Gynecol Scand. 2019;98(4):413-422. DOI: 10.1111/aogs.13505.
34. Vikhareva O, Rickle GS, Lavesson T, Nedopekina E, Brandell K, Salvesen KA. Hysterotomy level at Cesarean section and occurrence of large scar defects: a randomized single–blid trial. Ultrasound Obstet Gynecol. 2019;53:438-442. DOI: 10.1002/uog.20184.
35. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Med Bras. 2019;65(5):714-721.
36. Shapira M, Mashiach R, Meller N, Watad H , Baron A, Bouaziz J, et al. Clinical success rate of extensive hysteroscopic cesarean scar defect excision and correlation to histologic findings. J Minim Invasive Gynecol. 2020;27(1):129-134. DOI: 10.1016/j.jmig.2019.03.001.
37. Yang J, Zhang J, Shi Y, Shui J, Oian H. Trird-Trimester Spontaneus Uterine Rupture Afte Ultrasound-Guided High-Intensity Focused Ultrasound Therapy. Maternal-Fetal Medicine. 2024;6(1):57-59.

Publication of the article:

«Bulletin of problems biology and medicine», 2024 Issue 3, 174, 50-63 pages, index UDC 618.14–089–06(048.8)

DOI:

10.29254/2077-4214-2024-3-174-50-63