Kovyda N. Optimization of the diagnosis of the uterine scar defect after cesarean section

Studies have shown that all surveyed women were of childbearing age, determining the age composition of women in this group showed that in all subgroups of surveyed non-pregnant women the largest group of women was between 20 and 25 years. At the same time, most women had high school and college education level. Determining the anamnestic data on gynecological diseases in the examined non-pregnant women before the pregnancy that ended in CS showed that the most common in these women were observed PID. Determination of data on the state of somatic health in women before pregnancy, which ended in CS, showed that the examined women did not have severe forms of extragenital diseases. Pregnancy that ended in women with previous CS was complicated. Childbirth that ended in the previous CS was also often complicated. Most newborns born from women with the history of CS were in an abnormal condition. Inflammatory complications in the postoperative period occurred in all examined women who underwent CS. A significant number of women in the postoperative period had anemia. After undergoing CS, the examined women had changes in their menstrual function and showed signs of its disorders. The results of studies of the microbiocenosis of urogenital organs in non-pregnant women with US after CS showed that such women had a significant increase in the number of microorganisms in the staphylococcus group. Associations of different species of opportunistic pathogenic microflora were found in the microbial spectrum, which included gram-positive cocci, enterobacteria (Escherichia coli and Klebsiella, Enterobacter in combination with fungi of the genus Candida). Detection of sexually transmitted infections in non-pregnant women with incapable US after CS showed that such women were much more likely to have STI than women with capable uterine scar. Representatives of sexually transmitted infections in the examined women were found in associations with cocobacillary microflora and Candida on the background of reduced rate of lactobacilli. Determining the structure of indications for previous CS in the examined women revealed that the most common delivery by CS surgery occurred in the case of diagnosis of fetal distress in childbirth. In most women, previous delivery by CS surgery took place in an emergency. Pregnancy in surveyed women with US after previous CS was often complicated. The most common complication was the threat of abortion at different stages of pregnancy. Preconception care and intensive monitoring of the pregnant woman before delivery allowed to significantly reduce the incidence of complications in the postoperative period in the examined women. Ultrasound examination of the uterus performed in non-pregnant women with US after previous CS revealed the presence of various changes. The evaluation and statistical and mathematical calculation of the results of ultrasound examination of the uterus and postoperative US after previous CS in non-pregnant women allowed to create a scale for assessing the state of uterine scar after previous CS in non-pregnant women. The obtained data on changes in fetal ultrasound in pregnant women with uterine scar in the dynamics of pregnancy show that from the second trimester of pregnancy in women with uterine scar after the previous CS there is a decrease in the main indicators of fetal development. An important ultrasound diagnostic criterion for the condition of the scar after the previous CS was to determine the average value of Doppler parameters of uterine vessels in non-pregnant women. In women with uterine scar who became pregnant after previous CS at the pre-pregnancy stage, changes in blood flow in the uterine arteries and changes in IAP were determined.In women with incapable uterine scar, the most pronounced changes in the indices of vascular resistance in the uterine arteries were determined. The proposed, as a result of research, an additional new indicator, which is determined by Doppler examination of uterine vessels and is IAPP, found that women with US after previous CS in the dynamics of pregnancy is a decrease compared to that in healthy pregnant women. IAPP changed relative to the control group at all stages of pregnancy. The rate of IAPP in pregnant women with incapable uterine scar after previous CS was lower than in women in the control group. Morphological studies have shown that the failure of the scar after the previous CS was characterized by more pronounced structural changes in the form of disturbances in the architecture and areas of homogenization of myometrial tissue, degenerative changes in muscle fibers and disorders of the microcirculatory tract.Conducted pathomorphological, histochemical and immunohistochemical studies suggest that the state of the myometrium, vascular component and regenerative capacity is much lower. Such changes can negatively manifest themselves with excessive functional load on the uterine wall during pregnancy and childbirth