Local necrosis of myometrium in the scarr zone after cesarean section: risk factors, clinical picture, treatment

Objective. Determination of risk factors and stratification of clinical variants of local myometrial necrosis formation in the area of the suture (scarr) on the uterus on different days after cesarean section. Material and methods. The study included 75 patients who underwent cesarean section. The main group consisted of 38 patients with local necrosis of myometrium in the area of the uterine suture, hospitalized in the gynecological department on the 8-98th day after cesarean section. The control group (n=37) was formed of patients delivered by cesarean section with uncomplicated course of the postpartum period in 64.9% of observations, 18.9% of patients had elevated body temperature to subfebrile values, 16.2% had mild anemia, in order to determine the risk factors for the development of local necrosis of myometrium in the suture zone. The results of clinical-anamnestic, laboratory, ultrasound and morphological methods of research, statistical and retrospective analysis of medical records were analyzed. Results. The following causes of local myometrial necrosis formation in the uterine suture zone after cesarean section were revealed: pregnancy complications with low placenta location, exacerbation of genitourinary diseases and chorion detachment, duration of labor ≥6 h and waterless period ≥12 h, emergency cesarean section, single-row suturing of the uterus during cesarean section, aggravated postpartum period. The distinctive features of the course of clinical variants of local myometrial necrosis in the uterine suture zone depending on the terms of its diagnosis: 8-42nd, 43-70th, 71-98th days after cesarean section were evaluated. Conclusion. The presented stratification of clinical variants of local necrosis of myometrium in the uterine suture zone contributes to accurate routing of patients, allows to avoid incorrect interpretations of symptoms and empirical therapy.