V.F. NESTEROV, G.B. MALYGINA, N.V. KOSOVTSOVA

Ural Research Institute of Maternity and Childhood, Ekaterinburg

  Contact details:

Nesterov V.F. — PhD (Medicine), Senior Researcher, Head of the Obstetric Department

Address: 1 Repin St., 620028 Ekaterinburg, Russian Federation, tel.: +7 (343) 371-42-93, e-mail: dr.nesterov2014@yandex.ru

A scar on the uterus is a central problem of modern obstetrics. The use of shear wave elastography makes it possible to determine the elasticity of the scar tissue on the uterus and its adequacy.

The purpose — to evaluate the efficiency of using ultrasonic shear wave elastography in diagnosing the condition of the uterine scar from a caesarean section (CS).

Material and methods. The study included 63 pregnant women with an uterine scar from a caesarean section, who were divided into 2 groups according to the intraoperative state of the scar: group 1 (main group) — 19 patients with an «inferior» uterine scar, group 2 (comparison group) — 44 patients, with an «adequate» uterine scar. Before delivery, in addition to conventional ultrasound examination, ultrasonic shear wave elastography was performed, and the stiffness coefficient was determined. Correlation analysis of the most significant ultrasonic markers with the state of the scar according to the histological examination was carried out.

Results. It was established that ultrasound diagnostics plays an important role in assessing the state of the uterine scar. According to the results of a traditional examination, the most significant marker of an inferior uterine scar is the «hyperechogenicity» of the lower segment, which was naturally more common in patients of the main group. Carrying out ultrasonic shear wave elastography made it possible to determine the stiffness coefficient of the lower segment, which was 2 times higher in patients of the main group. A significant correlation was found between an inferior uterine scar from a caesarean section and an increased stiffness coefficient (r = 0.43, p = 0.03; 95% confidence interval 12.4–17.3). Histological examination of excised scars showed that inferior scars on the uterus were represented by immature connective tissue, with an abundance of fibroblasts.

Conclusion. Sufficiently high reliability of elastographic study data allows regarding it as an informative method for assessing the state of the uterine scar after cesarean section.

Key words: scar on the uterus, elastography, caesarean section operation, stiffness coefficient.

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