A new approach to the diagnosis and surgical treatment of uterine scar defect after cesarean section

Introduction. An increase in the number of cesarean sections in the world leads to an increase in cases of formation of scar defects on the uterus, which requires attention and the use of new diagnostic and treatment methods. Studying the healing processes of the myometrium is key to preventing the formation of a uterine scar defect, and improvements in diagnostic methods and surgical techniques can reduce the risk of recurrence of a uterine scar defect. Purpose of the study. To develop an effective algorithm for the management of women with a uterine scar defect at the stage of preparation for pregnancy. Materials and methods. A prospective randomized cohort study was conducted using a random number generator method with the participation of 100 women with a uterine scar defect after cesarean section. The participants were divided into two groups: in the first group (35 women), surgical treatment was performed using an anchor thread and a collagen-based hemostatic matrix, while in the second group (65 women), surgical treatment was carried out in the traditional way (laparoscopic metroplasty without the use of additional techniques). Results. A mathematical model has been developed for predicting the risk of recurrence of a uterine scar defect. Using the method of step-by-step discriminant analysis, the most informative predictors of the formation of a recurrent uterine scar defect were identified: shear wave magnitude indicators according to ultrasound elastography, the presence of a cyst in the uterine scar area, the expression of receptors for progesterone and estradiol in the endometrial glands, the expression of CD20 cells and CD138 cells. plasma cells according to an immunohistochemical study of the endometrium. Conclusion. Understanding the main reasons for the formation of a scar defect and the risk factors for its recurrence will make it possible to more accurately predict the outcomes of laparoscopic metroplasty and choose the most appropriate treatment tactics for each specific patient, which, in turn, can improve the overall treatment results and the quality of life of women