GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum7601710.26442/20795696.2022.1.201356REVIEWОБЗОРReview ArticleRisk factors and mechanisms of uterine scar defects formation after caesarean section: A reviewФакторы риска и механизмы формирования дефектов рубца на матке после операции кесарева сеченияhttps://orcid.org/0000-0002-5508-3611SidorovaTatiana A.СидороваТатьяна Анатольевна
Russian Federation

Graduate Student

аспирант гинекологического отд-ния

t_sidorova@oparina4.ruhttps://orcid.org/0000-0002-6795-1033MartynovSergey A.МартыновСергей Александрович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, вед. науч. сотр. гинекологического отд-ния

t_sidorova@oparina4.ruKulakov National Medical Research Center for Obstetrics, Gynecology and PerinatologyФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России1501202224111171307202123032022Copyright ©; 2022, Consilium MedicumCopyright ©; 2022, ООО "Консилиум Медикум"2022Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/76017

The objective of the review was to summarize information and analyze the literature regarding the risk factors for scar defects formation on the uterus after сaesarean section, as well as features of tissue repair after surgery. The frequency of сaesarean section throughout the world continues to increase and is accompanied by a high level of scar defects formation leading to many gynecological and obstetrical complications. Studying causes and mechanisms of defects formation is important as it facilitates the development of preventive measures and optimal approach for managing patients with сaesarean section scar defects in the future.

Целью обзора стал анализ данных литературы и обобщение информации относительно факторов риска формирования дефектов рубца на матке после операции кесарева сечения. Высокая частота кесарева сечения в мире сопровождается ростом распространения указанных дефектов, приводящих к ряду серьезных осложнений как вне, так и во время последующей беременности и родов. Тщательное изучение биологических основ процессов репарации, сопутствующей патологии у беременной, особенностей выполнения операции кесарева сечения служит важным звеном в формировании групп риска по возникновению дефектов рубца на матке после кесарева сечения и профилактике данных нарушений.

cesarean sectioncesarean scar defectкесарево сечениедефект рубца на матке после кесарева сеченияDonnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril. 2020;113(4):704-16. DOI:10.1016/j.fertnstert.2020.01.037Robson SJ, de Costa CM. Thirty years of the World Health Organization`s target caesarean section rate: time to move on. Med J Aust. 2017;206:181-5. DOI:10.5694/mja16.00832Betrán AP, Ye J, Moller A-B, et al. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343. DOI:10.1371/journal.pone.0148343Здравоохранение в России. 2021. Статистический сборник. М.: Росстат, 2021. Режим доступа: https://gks.ru/bgd/regl/b21_34/Main.htm Ссылка активна на 16.02.2022 [Public health in Russia. 2021. Statistical Digest. Moscow: Rosstat, 2021. Available at: https://gks.ru/bgd/regl/b21_34/Main.htm Accessed: 16.02.2022 (in 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;15(3):4-8 [Krasnopol'skii 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 (in Russian)]. DOI:10.17116/rosakush20151534-8Venturella R, Quaresima P, Micieli M, et al. Non-obstetrical indications for cesarean section: a state-of-the-art review. Arch Gynecol Obstet. 2018;298(1):9-16. DOI:10.1007/s00404-018-4742-4Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95. DOI:10.3238/arztebl.2015.0489Клинические рекомендации МЗ РФ. Роды одноплодные, родоразрешение путем кесарева сечения. М. 2021. Режим доступа: http://minzdravrm.ru/wp-content/uploads/2021/07/Rodi_odnoplodtii_rodorazrechenie_putem_kesareva.pdf Ссылка активна на 16.02.2022 [Klinicheskie rekomendatsii MZ RF. Rody odnoplodnye, rodorazreshenie putem kesareva secheniia. Moscow. 2021. Available at: http://minzdravrm.ru/wp-content/uploads/2021/07/Rodi_odnoplodtii_rodorazrechenie_putem_kesareva.pdf Accessed: 16.02.2022 (in Russian)].Мартынов С.А. Дефект рубца на матке после кесарева сечения: диагностика и лечение вне беременности. Гинекология. 2020;22(3):6-10 [Martynov SA. Cesarean scar defects: diagnosis and treatment in non-pregnant women. Gynecology. 2020;22(3):6-10 (in Russian)]. DOI:10.26442/20795696.2020.3.200189Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol. 2009;34(1):90-7. DOI:10.1002/uog.6395Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, et al. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30(12):2695-702. DOI:10.1093/humrep/dev240Vikhareva Osser O, Valentin L. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol. 2011;117(3):525-32. DOI:10.1097/AOG.0b013e318209abf0Bij de Vaate AJM, Brölmann HAM, van der Voet LF, et al. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2010;37(1):93-9. DOI:10.1002/uog.8864Van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014;121(2):236-44. DOI:10.1111/1471-0528.12542Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril. 2017;107(1):289-96.e2. DOI:10.1016/j.fertnstert.2016.09.033Tanimura S, Funamoto H, Hosono T, et al. New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect. J Obstet Gynaecol Res. 2015;41(9):1363-9. DOI:10.1111/jog.12738Gubbini G, Centini G, Nascetti D, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol. 2011;18(2):234-7. DOI:10.1016/j.jmig.2010.10.011Defrère S, Lousse JC, González-Ramos R, et al. Potential involvement of iron in the pathogenesis of peritoneal endometriosis. Mol Hum Reprod. 2008;14(7):377-85. DOI:10.1093/molehr/gan033Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373-81. DOI:10.1097/01.AOG.0000218690.24494.ceNaji O, Wynants L, Smith A, et al. Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features. Ultrasound Obstet Gynecol. 2013;41(6):672-8. DOI:10.1002/uog.12423Mynbaev O, Babenko TI, Ahmadi F, et al. Uterine Morbidity: Cesarean Section Scar Complications. In: A. Tinelli, L. Alonso Pacheco, S. Haimovich, editors. Hysteroscopy. Springer, Cham, 2018; p. 421-68. DOI:10.1007/978-3-319-57559-9_41Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obst Gynecol. 2005;192(5):1458-61. DOI:10.1016/j.ajog.2004.12.074Thurn L, Lindqvist PG, Jakobsson M, et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG. 2016;123(8):1348-55. DOI:10.1111/1471-0528.13547Roberge S, Demers S, Girard M, et al. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol. 2016;214(4):507.e1-e6. DOI:10.1016/j.ajog.2015.10.916Hayakawa H, Itakura A, Mitsui T, et al. Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand. 2006;85(4):429-34. DOI:10.1080/00016340500430436CORONIS collaborative group; Abalos E, Addo V, Brocklehurst P, et al. Caesarean section surgical techniques: 3 year follow-up of the CORONIS fractional, factorial, unmasked, randomised controlled trial. Lancet. 2016;388(10039):62-72. DOI:10.1016/S0140-6736(16)00204-XBamberg C, Hinkson L, Dudenhausen JW, et al. Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: a randomized controlled trial. Acta Obstet Gynecol Scand. 2017;96(12):1484-9. DOI:10.1111/aogs.13213Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG. 2010;117(9):1119-26. DOI:10.1111/j.1471-0528.2010.02631.xChen Y, Han P, Wang YJ, Li YX. Risk factors for incomplete healing of the uterine incision after cesarean section. Arch Gynecol Obstet. 2017;296(2):355-61. DOI:10.1007/s00404-017-4417-6Vikhareva O, Rickle GS, Lavesson T, et al. Hysterotomy level at Cesarean section and occurrence of large scar defects: a randomized single-blind trial. Ultrasound Obstet Gynecol. 2019;53(4):438-42. DOI:10.1002/uog.20184Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008;31(1):72-7. DOI:10.1002/uog.5200Han G, Ceilley R. Chronic Wound Healing: A Review of Current Management and Treatments. Adv Ther. 2017;34(3):599-610. DOI:10.1007/s12325-017-0478-yWang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009;34(1):85-9. DOI:10.1002/uog.6405Ryo E, Sakurai R, Kamata H, et al. Changes in uterine flexion caused by cesarean section: correlation between post-flexion and deficient cesarean section scars. J Med Ultrason. 2016;43(2):237-42. DOI:10.1007/s10396-015-0678-5Woodd SL, Montoya A, Barreix M, et al. Incidence of maternal peripartum infection: A systematic review and meta-analysis. PLoS Med. 2019;16(12):e1002984. DOI:10.1371/journal.pmed.1002984Taylor M, Pillarisetty LS. Endometritis. [Updated 2021 Apr 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553124/ Accessed: 16.02.2022Walfisch A, Beloosesky R, Shrim A, Hallak M. Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol. 2014;211(5):446-52. DOI:10.1016/j.ajog.2014.05.027Клеменов А.В., Ткачева О.Н., Верткин А.Л. Дисплазия соединительной ткани и беременность (обзор). Терапевтический архив. 2004;79(11):80-3 [Klemenov AV, Tkacheva ON, Vertkin AL. Connective tissue dysplasia and pregnancy (review). Terapevticheskii Arkhiv. 2004;79(11):80-3 (in Russian)].Кесова М.И. Беременность и недифференцированная дисплазия соединительной ткани: патогенез, клиника, диагностика.: дис. … докт. мед. наук. М. 2012. Режим доступа: https://www.dissercat.com/content/beremennost-i-nedifferentsirovannaya-displaziya-soedinitelnoi-tkani-patogenez-klinika-diagno Ссылка активна на 16.02.2022 [Kesova MI. Beremennost' i nedifferentsirovannaia displaziia soedinitel'noi tkani: patogenez, klinika, diagnostika.: dis. … dokt. med. nauk. Moscow. 2012. Available at: https://www.dissercat.com/content/beremennost-i-nedifferentsirovannaya-displaziya-soedinitelnoi-tkani-patogenez-klinika-diagno Accessed: 16.02.2022 (in Russian)].Кузин М.И., Костюченок Б.М. Раны и раневая инфекция: Рук-во для врачей. 2-е изд., перераб. и доп. М.: Медицина, 1990; с. 38-82 [Kuzin MI, Kostiuchenok BM. Rany i ranevaia infektsiia: Ruk-vo dlia vrachei. 2-e izd., pererab. i dop. Moscow: Meditsina, 1990; p. 38-82 (in Russian)].Gonzalez AC, Costa TF, Andrade ZA, Medrado AR. Wound healing – A literature review. An Bras Dermatol. 2016;91(5):614-20. DOI:10.1590/abd1806-4841.20164741Lindley LE, Stojadinovic O, Pastar I, Tomic-Canic M. Biology and Biomarkers for Wound Healing. Plast Reconstr Surg. 2016;138(3 Suppl.):18S-28S. DOI:10.1097/PRS.0000000000002682Qing C. The molecular biology in wound healing & non-healing wound. Chinese J Traumatol. 2017;20(4):189-93. DOI:10.1016/j.cjtee.2017.06.001Farrington-Rock C, Crofts NJ, Doherty MJ, et al. Chondrogenic and adipogenic potential of microvascular pericytes. Circulation. 2004;110:2226-32. DOI:10.1161/01.CIR.0000144457.55518.E5Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A. Uterine Wound Healing: A Complex Process Mediated by Proteins and Peptides. Curr Protein Pept Sci. 2017;18:125-8. DOI:10.2174/1389203717666160322145939Ingber DE. Control of capillary growth and differentiation by extracellular matrix. Use of a tensegrity (tensional integrity) mechanism for signal processing. Chest. 1991;99(3 Suppl.):34S-40S.Pienta KJ, Coffey DS. Cellular harmonic information transfer through a tissue tensegrity-matrix system. Med Hypotheses. 1991;34(1):88-95. DOI:10.1016/0306-9877(91)90072-7Ingber DE. Cellular tensegrity: defining new rules of biological design that govern the cytoskeleton. J Cell Sci. 1993;104(Pt. 3):613-27. DOI:10.1242/jcs.104.3.613Ермаков А.С. Теория тенсегрити и пространственная организация живого. Онтогенез. 2018;49(2):101-15 [Ermakov AS. The theory of tensegrity and spatial organization of living matter. Russian Journal of Developmental Biology. «Ontogenez». 2018;49(2):101-15 (in Russian)].Zwanenburg PR, Timmermans FW, Timmer AS, et al. A systematic review evaluating the influence of incisional Negative Pressure Wound Therapy on scarring. Wound Repair Regen. 2021;29(1):8-19. DOI:10.1111/wrr.12858Wang Z, Huang X, Zan T, et al. A modified scar model with controlled tension on secondary wound healing in mice. Burns Trauma. 2020;8:tkaa013. DOI:10.1093/burnst/tkaa013Kilpadi DV, Lessing C, Derrick K. Healed porcine incisions previously treated with a surgical incision management system: mechanical, histomorphometric and gene expression properties. Aesthetic Plast Surg. 2014;38(4):767-78. DOI:10.1007/s00266-014-0339-xPrevena Incision Management System Instructions for Use for Clinicians. KCI, San Antonio. 2013. Available at: https://www.mykci.com/-/media/Project/Acelity/Acelity-Base-Sites/shared/PDF/USA-PDF/prevena-restor-incision-management-system-instructions-for-use.pdf?la=en&hash=07B959117CDC376A20B784ACEDFE715D Accessed: 16.02.2022Пекарев О.Г., Майбородин И.В., Пекарева Е.О., и др. Применение стволовых клеток для улучшения репаративных свойств рубца миометрия. Доктор.Ру. 2017;3(132):20-5 [Pekarev OG, Maiborodin IV, Pekareva YeO. Using stem cells to improve myometrial scar repair. Doctor.Ru. 2017;3(132):20-5 (in Russian)].