CLINICAL-MORPHOLOGICAL EVALUATION OF THE QUALITY OF THE UTERINE SCAR TISSUE AFTER CAESAREAN SECTION

Purpose: Caesarean section (C.S.) is the most commonly performed operative procedure of the uterus in women of reproductive age. Each of these women increases their likelihood of complications in subsequent pregnancies. There is an obsolete law in obstetrics: once a cesarean, always a cesarean, due to the danger of failure of the uterine scar tissue and the greatly increased possibility of uterine rupture. This necessitates the application of various methods of assessing the sufficiency of the scar tissue before planning further deliveries. The most accurate methods for determining the structure of a tissue are histological, which by their nature can not be used during the pregnancy but they can correlate to clinical ones. Materials/Methods: Prospective study of 40 pregnant women with previous C.S., divided into groups according to the interval between the operations. Another subsequent division of subgroups to the number of Caesarean sections was made. The morphological indicators were compared to a control group of dermal scar from the same patients. The results of the clinical methods were to be compared with the results of the same patients from the morphological studies. We used clinical methods such as the history of the previous pregnancies and puerperal period, history of previous operations and the recovery after them, ultrasound examination and evaluation of the anterior uterine wall preoperatively. The morphological methods used are: Hematoxylin & eosin staining (H&E), followed by Masson Trichrome for collagen; Weigert-Van Gieson staining for elasticity; staining of immunohistochemistry MIB-1 (Ki-67) for cell proliferation. Results: The study group was presented by patients with one or more previous C.S. that were divided in subgroups. The shortest inter-delivery interval was 14 months, the longest - 19 years. The shorter the period between the C.S.s was, the thinner the myometrium. Cases of abnormal healing have been observed, including: myometrial hyperplasia, adenomyosis, myofiber disarray, elastosis, inflammation, fibroids, keloids. These results can be compared to clinical data from patients but mainly with the number of previous C.S. or those with a brief period between them. Conclusions: The results from our research proved that multiple C.S. is risk factors for larger defects of the uterine scar but not mandatory. The likelihood of prolonged healing time was higher in cases of more than one C.S. The dimensions of the surgical incision are associated with clinical symptoms such as postmenstrual smears, dysmenorrhoea and chronic pelvic pain.