Volume 03 Issue 10-2023
65
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
65-71
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Around the world, the number of caesarean sections is increasing every year. The purpose of the study was to study
the consistency of the uterine scar after cesarean section in pregnant women of reproductive age; 103 pregnant
women and the outcomes of their births were studied. Research and scientific work were carried out for 2020-2022.
on the basis of the obstetric department of the multidisciplinary clinic of SamSMU. Based on clinical data, objective
examination, ultrasound and Doppler measurements, as well as the amount of collagen type XXVI, in 66 pregnant
women the condition of the postoperative scar was assessed as satisfactory and in 37 as insolvent.
KEYWORDS
Viability criteria, uterine scar, cesarean section (CS), type XXVI collagen.
INTRODUCTION
Around the world, the number of caesarean sections is
increasing every year. This is influenced by the rapid
development of modern medical science, the
improvement of surgical techniques, the emergence of
new suture materials and broad-spectrum antibiotics,
the improvement of anesthesiological care, as well as
changes in society’s attitude towards childbirth.
Caesarean section (CS) is an operative method of
delivery that is widely used at the moment. According
to the Ministry of Health for 2022, we registered 932.2
Research Article
IMPROVING THE DIAGNOSTICS OF UTERUS SCAR AFTER CESAREAN
SECTION
Submission Date:
October 20, 2023,
Accepted Date:
October 25, 2023,
Published Date:
October 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue10-12
Kurbaniyazova Venera Enverovna
Samarkand State Medical University, Samarkand, Uzbekistan
Kurbaniyazova Feruza Zafarjanovna
Samarkand State Medical University, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 10-2023
66
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
65-71
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
thousand births, which is the highest figure since
independence. The total fertility rate (number of births
per 1,000 inhabitants) was 26.2
–
in 2022, which falls
into the category of countries with a “moderately
high” fertility rate. The frequency of surgical births in
Uzbekistan is about 23% of all births. According to
statistics from the Republic of Uzbekistan for 2017-
2022, from 5100 to 5897 women per year give birth
surgically, and the number of women with a uterine
scar increased from 568 to 618, with the predominant
number of women with one scar. The majority of
women who completed childbirth through CS
corresponded to district medical associations. Among
them, primiparous women ranged from 10.5% to 17.7%.
During pregnancy, 77.2% of women had various somatic
diseases,
such
as:
obesity,
myopia,
chronic
pyelonephritis, chronic gastritis, anemia, hypertensive
conditions, neurocirculatory dystonia, hydronephrosis,
varicose veins. In 92.3% of those who underwent a CS,
repeated births ended with a repeat cesarean section
with removal of the postoperative scar. And only 7% of
women with one uterine scar were delivered through
the vaginal canal during repeated births. This shows
the need to study the reasons for the increase in CS,
improve the diagnostics of consistency and
development.
Purpose of work was to study the consistency of the
uterine scar after cesarean section in pregnant women
of reproductive age.
Materials and methods. The study is based on a clinical
and laboratory examination of 103 women of
reproductive age with a history of one uterine scar,
who were under observation in the department of
obstetrics and gynecology of the multidisciplinary
clinic of Samarkand State Medical University for the
period from 2020 to 2022. During clinical and laboratory
examination, pregnant women were divided into 2
groups: Group I - with a stable scar (n=66), Group II
with an incompetent scar (n=37). Each of these groups
was divided into subgroups according to birth
outcomes: “A”
-
with natural birth, “B”
- birth by
cesarean section. Also, 68 postpartum women were
included in the main group for rehabilitation, and the
remaining 35 were included in the comparison group
for clinical assessment of the condition of the scar in
the postoperative period and rehabilitation.
The work used general clinical research methods
(general blood and urine analysis, vaginal smear,
assessment of hemostasis), as well as special research
methods, including: laboratory research methods
(determining the amount of type XXVI collagen by
ELISA, morphological examination of the scar area),
instrumental methods (ultrasound, Dopplerometry of
uterine vessels).
Variation-statistical processing of the study results was
carried out using the Statistica 6.0 program,
determining the main indicators of variation: mean
value (M), mean errors (m), standard deviation (p). The
Volume 03 Issue 10-2023
67
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
65-71
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
reliability of the results obtained was determined using
the Student's test. The difference between two means
is considered significant if the p-parameter is less than
0.05. The confidence level was at least 95%.
Results. Research and scientific work was carried out
for 2020-2022. on the basis of the obstetric department
of the multidisciplinary clinic of SamSMU, based on the
analysis of the results of a comprehensive examination
and dynamic observation of 103 women of
reproductive age with one scar on the uterus after
cesarean section, during pregnancy and in the
postpartum period. The age of the women ranged
from 18 to 40 years, the average age was 24.5±4.1
years.
Criteria for inclusion in the study:
-
written consent of pregnant women;
-
pregnant women with one scar on the uterus after
one caesarean section in history
-
gestational age 37 weeks or more at the time of
previous caesarean section
Exclusion criteria from the study:
•
pregnant women with scars on the uterus after
two or more caesarean sections;
•
use of T- and J-type incisions on the uterus during a
previous caesarean section
•
History of uterine rupture;
•
primary reconstructive operations on the uterus,
resection of the uterine angle, myomectomy and
other gynecological operations
•
the presence of other severe obstetric or
extragenital pathology in the acute stage.
•
Oncological diseases of various localizations or
high-risk groups
The intergravid period of pregnant women (from the
last CS operation to the current pregnancy) ranged
from 1 to 3 years (on average 1.8±0.8 years).
After the first CS, the average levels of collagen type
XXVI did not differ in both groups during the second
pregnancy, but after delivery its indicator showed
significant changes in the two groups. Thus, in
subgroup IA, the concentration of type XXVI collagen
was 322.28±34.5 ng/ml; upon re-examination 3 months
after birth, a significant decrease in the average
concentration of type XXVI collagen was noted, which
amounted to 164.12±6.25 ng/ml.
The average concentration of type XXVI collagen in the
main group during pregnancy was 328.22±17.5 ng/ml,
and 3 months after birth - 363.1±48.4 ng/ml. This
indicates
the
effectiveness
of
rehabilitation
procedures. The data obtained show that collagen
type XXVI can be taken as a predictor of the choice of
method of delivery.
In pregnant women with a uterine scar after CS, the
main criteria for scar failure on ultrasound were
Volume 03 Issue 10-2023
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International Journal of Medical Sciences And Clinical Research
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VOLUME
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SJIF
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(2021:
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(2022:
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(2023:
6.
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)
OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
deformation of the uterine cavity in the area of the
sutures, the presence of local folds and visualization of
the “niche” symptom in the area of the postoperative
scar.
37 pregnant women had an echo picture of the uterine
scar, characterized by the presence of atrophy and the
formation of a thin fibrous cover, a defect in the
uterine wall in the area of the scar, and inadequate
blood circulation along the scar. Uterine hypertonicity
in both study groups was 55.88% and 57.14%,
respectively; other pathological findings are reflected
in Figure No. 1.
Although 22.86% of pregnant women of the main
group and 19.11% of the comparison group were
diagnosed with echo signs of placental insufficiency,
11.42% and 11.76% of umbilical cord entanglement,
14.28% and 14.7% were diagnosed with ORP, this is not
always directly related with a uterine scar or a history
of CS, which is confirmed by statistical data.
Figure 1. Ultrasound data in the studied women (%)
According to ultrasound data, in 66 pregnant women
the presence of various elements located between full-
blooded capillaries and small-caliber capillaries was
revealed, indicating the
“consistency” of the uterine
scar.
According to the study data, at a period of 36-38
weeks, pregnant women were divided into 2 groups
14.70%
11.76%
19.11%
1.47%
55.88%
14.28%
11.42%
22.86%
0
57.14%
-20.00% -10.00%
0.00%
10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%
Fetal growth restriction syndrome
Umbilical cord entanglement
Placental insufficiency
Placenta previa
Hypertonicity of the uterus
Comparison
group
p<0,02
p<0,02
p<0,03
p<0,05
p=0,00..
Volume 03 Issue 10-2023
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(ISSN
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VOLUME
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ISSUE
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P
AGES
:
65-71
SJIF
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MPACT
FACTOR
(2021:
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
(Group I - 66 pregnant women with a clinically
“successful” scar, Group II
- 37 pregnant women with
an incompetent scar), based on the delivery data, each
of the groups was divided into 2 subgroups (A - with
natural birth, B - delivery by cesarean section): Group I
-
66 women with a clinically “significant” uterine scar,
admitted as planned. Group II consisted of 37 pregnant
women
who
were
diagnosed
with
uterine
incompetence and recommended for cesarean
section. But according to the birth outcomes, they
were also divided into 2 subgroups: Subgroup II A
included 13 women who were recommended for a
cesarean section, which they refused and were
admitted at 38 weeks or more in the second stage of
labor and had a natural delivery; Subgroup II B
consisted of 24 women with clinical signs of uterine
scar failure, who underwent repeat CS surgery as
recommended.
Figure 2. Distribution of pregnant women according to the condition of the postoperative scar
Conclusion
Based on clinical data, objective examination,
ultrasound and Doppler measurements, as well as the
amount of collagen type XXVI, in 66 pregnant women
the condition of the postoperative scar was assessed
as satisfactory and in 37 as insolvent.
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International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
ISSUE
10
P
AGES
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65-71
SJIF
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MPACT
FACTOR
(2021:
5.
694
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(2022:
5.
893
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(2023:
6.
184
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OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
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