A.V. MALUSHKO¹, I.B. FATKULLINA², I.D. SHCHEDRINA¹, S.M. ALEKSEYEV¹, V.R. SILAKOVA³

 ¹Leningrad region Clinical Hospital, Saint Petersburg

²Republic Clinical Prenatal Center, Ufa

³I.M. Sechenov First Moscow State Medical University, Moscow

Contact details:

Malushko A.V. — Head of the Gynecology Department

Address: 45 prospekt Lunacharskogo, bld. 2, 194291 Saint Petersburg, Russian Federation, tel.: +7 (812) 670-18-88, e-mail: a-malushko@mail.ru

Approaches to the uterine scar failure treatment include traditional surgical methods such as abdominal plasty with laparoscopic or laparotomic access. However, these methods are often accompanied by a high risk of complications and a long recovery period.

The purpose was to study possible complications and evaluate the effectiveness of vaginal access in order to correct the inconsistency of the uterine scar after cesarean section. It was established that the main advantages of vaginal metroplasty are minimal injury and invasiveness. It allows reducing the postoperative hospital stay of patients to a minimum and rehabilitation time almost by half. This surgical technique also reduces the risks of postoperative complications, purulent-infectious processes in the postoperative wound, and the risks of postoperative hematomas and adhesions, taking into account minimal access for surgical intervention. The choice of the optimal correction method should be based on the individual characteristics of the patient, the defect size and location, reproductive plans and the disease clinical manifestations. A personalized approach to treatment, taking into account all factors, makes it possible to maximize the therapy effectiveness and ensure the restoration of both the anatomical structure and functional properties of the uterus.

Key words: failed uterine scar after cesarean section, metroplasty, vaginal access.

REFERENCES

1. Bryunin D.V., Mikhaelyan N.S., Khokhlova I.D., Dzhibladze T.A., Ishchenko A.I., Gorbenko O.Yu. et al. Experience of laparoscopic correction of uterine scar failure after cesarean section. Arkhiv akusherstva i ginekologii im. V.F. Snegireva, 2018, vol. 5, no. 3, pp. 148–153 (in Russ.). DOI: 10.18821/2313-8726-2018-5-3-148-153
2. Garifullova Yu.V., Zhuravleva V.I. A rare clinical case of formation of an incompetent uterine scar after cesarean section in the late postoperative period. Prakticheskaya meditsina, 2020, vol. 18, no. 2, pp. 74–77 (in Russ.). DOI: 10.32000/2072-1757-2020-2-74-77
3. Ishchenko A.I., Trifonova N.S., Aleksandrov L.S. et al. Sposob metroplastiki pri povtornom kesarevom sechenii s pomoshch’yu rassasyvayushcheysya ankernoy niti i germetizatsii shvov amnioticheskimi obolochkami: patent RU2801415, Rossiyskaya Federatsiya, zayavka RU2023115921, zayavl. 18.06.2023, opubl. 08.08.2023 [Method of metroplasty in repeated cesarean section using an absorbable anchor thread and sealing the sutures with amniotic membranes: patent RU2801415, Russian Federation, application RU2023115921, declared 18.06.2023, published 08.08.2023].
4. Khasanov A.A., Zhuravleva V.I., Galautdinova D.I. Remote outcomes of reconstructive plastic surgery of an insolvent uterine scar using vaginal access. Prakticheskaya meditsina, 2017, vol. 8, no. 109 (in Russ.), available at: https://cyberleninka.ru/article/n/otdalennye-ishody-rekonstruktivnoy-plastiki-nesostoyatelnogo-rubtsa-na-matke-vlagalischnym-dostupom
5. Tsiv’yan B.L., Vardanyan S.V., Shaparnev A.V. et al. Vaginal access in the treatment of diseases of the uterus and appendages. Zhurnal akusherstva i zhenskikh bolezney, 2009, vol. 18, iss. 5 (in Russ.), available at: https://cyberleninka.ru/article/n/vlagalischnyy-dostup-v-lechenii-zabolevaniy-matki-i-pridatkov/viewer
6. Glukhov E.Yu., Oboskalova T.A., Stolin A.V., Spirin A.V., Butunov O.V. Scar on the uterus after cesarean section in the clinic and experiment. Rossiyskiy vestnik akushera-ginekologa, 2014, no. 1, pp. 10–11 (in Russ.).
7. Makukhina T.B., Pomortsev A.V. Features of ultrasound diagnostics and treatment tactics in the management of patients with pregnancy in a scar after cesarean section. Rossiyskiy elektronnyy zhurnal radiologii, 2012, vol. 2, no. 3, pp. 95–96 (in Russ.).
8. Ochilova D.S., El’tazarova G.Sh. Faktory riska nesostoyatel’nosti rubtsa na matke posle operatsii kesarevo sechenie [Risk factors for uterine scar failure after cesarean section]. Materialy I Mezhdunarodnoy (71 Vserossiyskoy) nauchno-prakticheskoy konferentsii “Aktual’nye voprosy sovremennoy meditsinskoy nauki i zdravookhraneniya”. Samarkand, Uzbekistan, [b. g.]. Pp. 142–143.
9. Rudenko A.A., Matveeva M.A., Mamin E.L., Bogdanova A.M. Uterine scar failure after cesarean section. Vestnik KazNMU, 2022, no. 1, pp. 79–80 (in Russ.).
10. Polyanin D.V., Mikhel’son A.A., Melkozerova O.A., Luk’yanova K.D. Controversial issues of uterine scar failure in the era of cesarean section epidemic. Ural’skiy meditsinskiy zhurnal, 2019, no. 5 (173), pp. 17–23 (in Russ.).
11. Malushko A.V., Shchedrina I.D., Alekseev S.M. et al. Non-developing pregnancy in the rudimentary horn of the uterus. Clinical case. Glavnyy vrach Yuga Rossii, 2025, no. 1 (99), pp. 6–10 (in Russ.).
12. Alekseev S.M., Malushko A.V., Komlichenko E.V. et al. Sposob vaginal’noy metroplastiki nesostoyatel’nogo rubtsa na matke posle operatsii kesareva secheniya. Patent no. 2840188 C1 Rossiyskaya Federatsiya, MPK A61B 17/42, A61B 17/04: zayavl. 29.10.2024: opubl. 19.05.2025 [Method of vaginal metroplasty of an incompetent uterine scar after cesarean section. Patent No. 2840188 C1 Russian Federation, IPC A61B 17/42, A61B 17/04: declared 10/29/2024: published 05/19/2025].
13. Ishchenko A.I., Trifonova N.S., Aleksandrov L.S. et al. Sposob metroplastiki pri povtornom kesarevom sechenii s pomoshch’yu rassasyvayushcheysya ankernoy niti i germetizatsii shvov amnioticheskimi obolochkami. Patent no. 2801415 C1 Rossiyskaya Federatsiya, MPK A61B 17/42: no. 2023115921: zayavl. 18.06.2023: opubl. 08.08.2023 [Method of metroplasty in repeat cesarean section using an absorbable anchor thread and sealing the sutures with amniotic membranes. Patent No. 2801415 C1 Russian Federation, IPC A61B 17/42: No. 2023115921: declared 06/18/2023: published 08/08/2023].