Title : Endometriosis of untenable uterine scar after cesarean section: Clinical picture, treatment
Abstract:
Caesarean section is one of the most frequently performed surgical interventions, with no downward trend worldwide. One of the current complications of caesarean section is the disruption of repair processes in the area of the scar. We would like to tell you about the modern gynecologic lesion - the failure of the scar on the uterus and its consequences, including those associated with it. We present the results of a study conducted on the basis of operational gynecology. Our study contained not only statistical methods of investigation, but also macroscopic visualization of pathological spots. An unviable uterus has numerous clinical symptoms that significantly reduce the quality of life of young patients in active reproductive age. The relevance of the study of this problem is the absence of specific clinical complaints in patients with untenable scars on the uterus. We made an attempt to identify the relationship between symptoms and endometrial lesions of pathological scar. In addition, we made an attempt to detect the causal factor in the formation of unviable scar on the uterus. The study we conducted included 58 patients out of 250 with an unviable scar on the uterus, who applied to the operative gynecology department of GBUZ MO “Moscow Regional Research Institute of Obstetrics and Gynecology named after academician V.I. Krasnopolsky. 58 patients out of 250 had complaints about clotting in the genital tract, lower abdominal pain, postmenopausal secretion (masking), infertility, painful menstruation, dyspepsia, urinary disorders. Since these symptoms are not pathognomic, the enaeometrical foci found in the unviable scar on the uterus by ultrasound and morphological study facilitated the mathematical analysis to identify a relationship with the symptoms and endometriosis of the scar on the uterus.
Relevance: Endometriosis is a disease with studied frequency of its occurrence, but the literature analysis did not show the exact prevalence of uterine scar endometriosis. The absence of specific picture does not reflect the real frequency of scar endometriosis, complicates timely diagnosis and the beginning of treatment.
The aim of the study: to evaluate the peculiarities of the course, diagnosis and treatment of endometriosis of an invalid uterine scar after cesarean section (CS).
Material and methods of the study: The study including 58 patients from 21 to 43 years old (Me = 32,5±0,57), who underwent surgical treatment (laparotomy access metroplasty) of symptomatic niches of large size in the uterine scar after CS, was carried out in the conditions of the department of operative gynecology of the State Budgetary Institution of Medical and Biological Research Institute named after academician V.I. Krasnopolsky. In the course of treatment, clinical and anamnestic analysis was clarified, instrumental, morphological and statistical methods of research (SPSS 16.0) were used.
Results and discussion: On admission the patients were performed transvaginal ultrasound (TVUSI): in 24.1% endometriod lesion of the failed scar was detected. The time interval between the last CS and the patients' visit to a medical institution averaged 5.55±0.32 years (6 months - 14 years).
Patients were hospitalized with complaints of: menstrual disorders (46.5%), pain (41.3%), inter- or postmenstrual “ointmental” discharge (33%), secondary infertility (10%) and dysuria (3%). Correlation analysis showed a moderate correlation between NRM endometriosis and pain symptom (p<0.05, r=0.209). All 58 patients underwent metroplasty of the untenable scar on the uterus after CS (NRM). Morphologic study of the excised scars revealed: fragments of smooth muscle tissue with endometrioid heterotopias (20.7%), leiomyoma of the uterine scar (3.4%). Obviously, uterine scar leiomyoma was interpreted as uterine scar endometriosis on TVUSI. Conclusion. At comparison of TVUSI, macroscopic imaging and morphological examination the frequency of NRM endometriosis was 20.7%. The diagnostic accuracy of NRM endometriosis at TVUSI was 85.7%. Observation of the patients during 6 months - 3 years after surgical excision of the failed scar on the uterus showed the absence of recurrences of scar endometriosis, which allows to recommend metroplasty as an effective method of treatment.
