INCONSISTENCY OF THE UTERINE SCAR, MODERN APPROACHES TO CORRECTION
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Abstract
Uterine scar failure after cesarean section is a pressing problem in modern gynecology with an incidence rate of 35% to 88% depending on the number of previous surgeries. This pathology is characterized by the formation of a defect in the scar area and can lead to menstrual irregularities, reproductive problems, and complications in subsequent pregnancies.
The paper presents a systematic review of modern approaches to the diagnosis and correction of uterine scar failure based on an analysis of scientific literature from the PubMed/MEDLINE, Cochrane Library, eLibrary.ru, and other databases.
Pathogenetic mechanisms of defective scar formation are considered, including two types of regeneration – substitution and restitution. The article analyzes diagnostic methods using transvaginal echography as the gold standard, magnetic resonance imaging, and hysteroscopy. Modern correction methods are presented, including conservative therapy, hysteroscopic interventions using robotic systems, laparoscopic correction with both scar tissue excision and an innovative approach without scar resection.
Particular attention is paid to robotic surgery using the da Vinci system, which has demonstrated high efficiency with an increase in the thickness of the myometrium to 9.25 mm and the absence of relapses. Promising areas of regenerative medicine are considered, including the use of platelet-rich plasma and tissue engineering methods with biodegradable scaffolds.
The need for a personalized approach to choosing a correction method is emphasized, taking into account the size of the defect, clinical manifestations, and the patient's reproductive plans.
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The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
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References
Savina LV, Yashchuk AG, Maslennikov AV, Savin AM, Shayakhmetov AM. Risk Factors for the Formation of Uterine Scar Failure after Cesarean Section. International Research Journal. 2022; 6(120): 107-112. Russian (Савина Л.В., Ящук А.Г., Масленников А.В., Савин А.М., Шаяхметов А.М. Факторы риска формирования несостоятельности рубца на матке после операции кесарева сечения //Международный научно-исследовательский журнал. 2022. № 6(120). С. 107-112.) doi: 10.23670/IRJ.2022.120.6.050
Lin PL, Hou JH, Chen CH. A common problem between gynecology, obstetrics, and reproductive medicine: Cesarean section scar defect. Taiwan J Obstet Gynecol. 2024; 63(4): 459-470. doi: 10.1016/j.tjog.2024.03.018
Torobaeva MT, Buyanova SN, Puchkova NV. Inadequate uterine scar after caesarean section as a separate nosology. Russian Bulletin of Obstetrician-Gynecologist. 2023; 23(3): 19-28. Russian (Торобаева М.Т., Буянова С.Н., Пучкова Н.В. Несостоятельный рубец на матке после кесарева сечения как отдельная нозология //Российский вестник акушера-гинеколога. 2023. Т. 23, № 3. С. 19-28.) doi: 10.17116/rosakush20232303119
Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril. 2020; 113: 704-716. doi: 10.1016/j.fertnstert.2020.01.037
Krasnopol'skiĭ VI, Buianova SN, Shchukina NA, Logutova LS. Uterine suture (scar) incompetence after cesarean section: Problems and solutions (an editorial). Russian Bulletin of Obstetrician-Gynecologist. 2015; 15(3): 4-8. Russian (Краснопольский В.И., Буянова С.Н., Щукина Н.А., Логутова Л.С. Несостоятельность шва (рубца) на матке после кесарева сечения: проблемы и решения (редакционная статья) //Российский вестник акушера-гинеколога. 2015. Т. 15, № 3. С. 4-8.) doi: 10.17116/rosakush20151534-8
Shchukina NA, Buianova SN, Chechneva MA, Zemskova NYu, Puchkova NV, Barto RA, et al. Causes of a postcesarean incompetent uterine scar: a role of connective tissue dysplasia. Russian Bulletin of Obstetrician-Gynecologist. 2018; 18(5): 4-11. Russian (Щукина Н.А., Буянова С.Н., Чечнева М.А., Земскова Н.Ю., Пучкова Н.В., Барто Р.А., и др. Причины формирования несостоятельного рубца на матке после кесарева сечения, роль дисплазии соединительной ткани //Российский вестник акушера-гинеколога.2018. Т. 18, № 5. С. 4-11.) doi: 10.17116/rosakush2018180514
Debras E, Capmas P, Maudot C, Chavatte-Palmer P. Uterine wound healing after caesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2024; 296: 83-90. doi: 10.1016/j.ejogrb.2024.02.045
Kogan OM, Voitenko NB, Zosimova EA, Martynova EN, Nersesyan DM, Bubnikovich AA. Algorithm for the management of patients with incompetence of postoperative uterine scar after a cesarean section, our clinical experience. Clinical practice. 2018; 9(3): 38-43. Russian (Коган О.М., Войтенко Н.Б., Зосимова Е.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. Т. 9, № 3. С. 38-43.) doi: 10.17816/clinpract 093 38-43
Xu X-J, Jia J-X, Sang Z-Q, Li L. Association of caesarean scar defect with risk of abnormal uterine bleeding: results from meta-analysis. BMC Women's Health. 2024; 24(1): 432. doi: 10.1186/s12905-024-03198-6
Shchukina NA, Blagina EI, Barinova IV. Causes of inefficient uterine scarring after caesarean section and methods of its prevention. Almanac of Clinical Medicine. 2015; 37: 85-92. Russian (Щукина Н.А., Благина Е.И., Баринова И.В. Причины формирования и методы профилактики несостоятельного рубца на матке после кесарева сечения //Альманах клинической медицины. 2015. № 37. С. 85-92)
Martynov SA. Cesarean scar defects: diagnosis and treatment in non-pregnant women. Gynecology. 2020; 22(3): 6-10. Russian (Мартынов С.А. Дефект рубца на матке после кесарева сечения: диагностика и лечение вне беременности //Гинекология. 2020. Т. 22, № 3. С. 6-10.) doi: 10.26442/20795696.2020.3.200189
Esetov MA, Esetov AM. E`xografiya v e`mbrional`nom periode. Beremennost` v rubce na matke. M.: Publishing house «Vidar-M», 2020. 128 p. Russian (Эсетов М.А. Эсетов А.М. Эхография в эмбриональном периоде. Беременность в рубце на матке. М.: Издательский дом «Видар-М», 2020. 128 с.)
Rosa F, Perugin G, Schettini D, Romano N, Romeo S, Podestà R, et al. Imaging findings of cesarean delivery complications: cesarean scar disease and much more. Insights Imaging. 2019; 10(1): 98. doi: 10.1186/s13244-019-0780-0
Strizhakov AN, Ignatko IV, Churganova AA, Aslanov AG. An Innovative Approach to Studying the State of the Uterine Scar after Cesarean Section on the Basis of a Comparative Study. Annals of the Russian Academy of Medical Sciences. 2021; 76(5): 429-435. Russian (Стрижаков А.Н., Игнатко И.В., Чурганова А.А., Асланов А.Г. Инновационный подход к изучению состояния рубца на матке после операции кесарево сечение на основании сравнительного исследования //Вестник РАМН. 2021. Т. 76, № 5. С. 429-435.) doi: 10.15690/vramn1291
Khudoyarkina DR, Turakulova ShE, Shopulotova ZA. Uterine scar and the latest trends in science. Eurasian Journal of Medical and Natural Sciences. 2024; 4(8): 13-17. Russian (Худоярова Д.Р., Туракулова Ш.Э., Шопулотова З.А. Рубец на матке и последние тенденции в науке //Евразийский журнал медицинских и естественных наук. 2024. Т. 4, № 8. С. 13-17)
Bakavičiūtė G, Špiliauskaitė S, Meškauskienė A, Ramašauskaitė D. Laparoscopic repair of the uterine scar defect – successful treatment of secondary infertility: a case report and literature review. Acta Med Litu. 2016; 23(4): 227-231. doi: 10.6001/actamedica.v23i4.3424
Galustyan MV, Kutsenko II, Borovikov IO, Magay AS. Possibilities of predicting uterine scar failure after cesarean section. Medical Herald of the South of Russia. 2021; 12(1): 54-61. Russian (Галустян М.В., Куценко И.И., Боровиков И.О., Магай А.С. Возможности прогнозирования несостоятельности рубца на матке после операции кесарева сечения //Медицинский вестник Юга России. 2021. Т. 12, № 1. С. 54-61.) doi: 10.21886/2219-8075-2021-12-1-54-61
Zermano S, Seminara G, Parisi N, Serantoni V, Arcie M ri, Biasioli A. Prenatal Detection and Conservative Management of Uterine Scar Dehiscence in Patient with Previous Uterine Rupture and Multiple Surgeries-A Case Report. Healthcare (Basel). 2024; 12(10): 988. doi: 10.3390/healthcare12100988
Chen Y-Y, Tsai C-C, Lan K-C, Ou Y-C. Preliminary report on the use of a levonorgestrel intrauterine system for the treatment of intermenstrual bleeding due to previous cesarean delivery scar defect. J Obstet Gynaecol Res. 2019; 45(10): 2015-2020. doi: 10.1111/jog.14060
Moore JF, Carugno J. Hysteroscopy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. 2025 Apr 6
Guan Z, Liu J, Bardawil E, Guan X. Surgical Management of Cesarean Scar Defect: The Hysteroscopic-Assisted Robotic Single-Site Technique. J Minim Invasive Gynecol. 2020; 27(1): 24-25. doi: 10.1016/j.jmig.2019.06.007
Zhang N-N, Wang G-W, Zuo N, Yang Q. Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection. BMC Pregnancy Childbirth. 2021; 21(1): 815. doi: 10.1186/s12884-021-04281-8
Operative gynecology. Endoscopic Surgery. 2021; 27(6): 56-63. Russian (Габузов Г.Г., Саврасов Г.В., Саакова А.Л. Место робота в оперативной гинекологии //Эндоскопическая хирургия. 2021. Т. 27, № 6. С. 56-63.) doi: 10.17116/endoskop20212706156
Ponomareva YuN, Loginova EA, Sementsova NA. Robot-assisted correction of incompetent uterine scar after cesarean section. Obstetrics and gynecology. 2021; 10: 143-152. Russian (Пономарева Ю.Н., Логинова Е.А., Семенцова Н.А. Робот-ассистированная коррекция несостоятельного рубца на матке после кесарева сечения //Акушерство и гинекология. 2021. № 10. С. 143-152.) doi: 10.18565/aig.2021.10.143-152
Lopes B, Sousa P, Alvites R, Branquinho M, Sousa A, Mendonça C, et al. The Application of Mesenchymal Stem Cells on Wound Repair and Regeneration. Appl. Sci. 2021; 11(7): 3000. doi: 10.3390/app11073000
Wu S, Sun S, Fu W, Yang Z, Yao H, Zhang Z. The Role and Prospects of Mesenchymal Stem Cells in Skin Repair and Regeneration. Biomedicines. 2024; 12(4): 743. doi: 10.3390/biomedicines12040743
Chicharro-Alcántara D, Rubio-Zaragoza M, Damiá-Giménez E, Carrillo-Poveda JM, Cuervo-Serrato B, Peláez-Gorrea P, Sopena-Juncosa JJ. Platelet Rich Plasma: New Insights for Cutaneous Wound Healing Management. J Funct Biomater. 2018; 9(1): 10. doi: 10.3390/jfb9010010
Bolton L. Platelet-Rich Plasma: Optimal Use in Surgical Wounds. Wounds. 2021; 33(8): 219-221
Zhang Z, Liu P, Xue X, Zhang Z, Wang L, Jiang Y, et al. The role of platelet-rich plasma in biomedicine: A comprehensive overview. iScience. 2025; 28(2): 111705. doi: 10.1016/j.isci.2024.111705