A.V. MALUSHKO¹, I.B. FATKULLINA², I.D. SHCHEDRINA¹, S.M. ALEKSEYEV¹, V.R. SILAKOVA³, M.V. FEDOROVA⁴

 ¹Leningrad region Clinical Hospital, Saint Petersburg

²Republic Clinical Prenatal Center, Ufa

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

⁴V.A. Almazov National Medical Research Center, Saint Petersburg

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

The article presents a comprehensive analysis of the effective transvaginal plastic surgery of an incompetent uterine scar as a method of surgical treatment. The study is based on the analysis of numerous clinical observations and systematization of data on using this method in obstetric practice.

The study demonstrates the high effectiveness of transvaginal plastic surgery: 90-95% of patients develop a competent scar after surgery. The method is characterized by low trauma, reduced rehabilitation terms and the possibility of extraperitoneal implementation. Particularly significant is the fact that after successful correction up to 90% of patients are subsequently able to bear a pregnancy and give birth through the natural birth canal. The obtained results make transvaginal plastic surgery a preferred method for correcting an incompetent uterine scar, subject to certain clinical conditions and careful selection of patients.

Key words: scar incompetence, surgical correction, transvaginal access, vaginal access, clinical outcomes.

REFERENCES

1. Filippov E.F., Pirozhnik E.G., Melkon’yants T.G., Tarabanova O.V., Ordokova A.A., Sokolova E.I., Popova N.A. Experience of using transvaginal extraperitoneal access in surgical treatment of uterine scar failure after cesarean section. Kubanskiy nauchnyy meditsinskiy vestnik, 2018, no. 25 (1), pp. 40–45 (in Russ.).
2. Podzolkova N.M., Demidov A.V., Osadchev V.B., Babkov K.V., Denisova Yu.V. Isthmocele: controversial issues of terminology, diagnostics and treatment. Ginekologiya, 2024, no. 26 (2), pp. 119–127 (in Russ.).
3. Martynov S.A. Uterine scar defect after cesarean section: diagnosis and treatment outside pregnancy. Ginekologiya, 2020, no. 22 (3), pp. 6–10 (in Russ.).
4. Valieva E.M., Vashchenko M.O. Metroplasty as a method of treating uterine scar failure after cesarean section and preventing complications associated with it. StudeNt ScieNce, 2019, vol. 2, no. 1, pp. 135–136 (in Russ.).
5. Garifullova Yu.V., Zhuravleva V.I. Plastic surgery of an incompetent uterine scar through the vagina with concomitant connective tissue dysplasia. Prakticheskaya meditsina, 2019, vol. 17, no. 4, pp. 85–87 (in Russ.).
6. Eremkina V.I., Garifullova Yu.V. Complications in plastic surgery of an incompetent uterine scar after cesarean section using vaginal access. Prakticheskaya meditsina, 2015, vol. 1, no. 4 (89), pp. 63–65 (in Russ.).
7. Eremkina V.I., Garifullova Yu.V. Reconstructive and restorative plastic surgery of an incompetent uterine scar using vaginal access outside of pregnancy. Prakticheskaya meditsina, 2014, vol. 1, no. 4 (80), pp. 46–48 (in Russ.).
8. Kogan O.M., Voytenko N.B., Zosimova E.A. Algorithm for managing patients with incompetent postoperative uterine scar after cesarean section. Klinicheskaya praktika, 2018, vol. 9, no. 9, pp. 38–43 (in Russ.).
9. Khasanov A.A., Zhuravleva V.I., Galautdinova D.I. Remote outcomes of reconstructive plastic surgery of an incompetent uterine scar using vaginal access. Prakticheskaya meditsina, 2017, no. 8 (109), pp. 168–170.
10. Konnon S.R., Shalaev O.N., Shmanaeva I.I. An interesting case of metroplasty for uteroperitoneal fistula using vaginal access. Vestnik RUDN, 2016, no. 2, pp. 98–102 (in Russ.).
11. Khudoyarkina D.R., Turakulova Sh.E. Uterine scar and the latest trends in science. Evraziyskiy zhurnal meditsinskikh i estestvennykh nauk, 2024, vol. 4, no. 38, pp. 13–17 (in Russ.).
12. Nozhnitseva O.N., Bezhenar’ V.F. The niche of the uterine scar after cesarean section — a new problem of women’s reproductive health. Zhurnal akusherstva i zhenskikh bolezney, 2020, vol. 69, no. 1, pp. 53–62 (in Russ.).
13. Sysoeva O.G., Komlichenko E.V. Diagnostics of uterine scar failure based on ultrasound and magnetic resonance imaging data (clinical observation)). Akusherstvo i ginekologiya: novosti, mneniya, obuchenie, 2024, vol. 12, no. 1, pp. 53–58 (in Russ.).
14. Glukhov E.Yu., Dikke G.B., Neff E.I., Glukhova V.E., Svyazhina A.V. Chronic endometritis and incompetent uterine scar after cesarean section. Remote results of metroplasty. Akusherstvo i ginekologiya, 2019, no. 2, pp. 126–134 (in Russ.).
15. Dodkhoeva M.F., Yuldosheva M.U. Caesarean section: problems after surgery. Vestnik akademii meditsinskikh nauk Tadzhikistana, 2016, no. 4, pp. 120–128 (in Russ.).
16. Shalaev O.N., Salimova L.Ya., Plaksina N.D. Vaginal surgery: natural access, wide possibilities. Vestnik RUDN, 2010, no. 6, pp. 174–179 (in Russ.).
17. Popov A.A. et al. Korrektsiya nesostoyatel’nosti rubtsa na matke razlichnym khirurgicheskim dostupom, reproduktivnye iskhody: informatsionno-metodicheskoe pis’mo [Correction of uterine scar failure by various surgical approaches, reproductive outcomes: information and methodological letter]. Moscow: MAKS Press, 2018. 12 p.
18. Garifullova Yu.V., Zhuravleva V.I. Plastic surgery of an incompetent uterine scar by vaginal access with concomitant connective tissue dysplasia. Prakticheskaya meditsina, 2019, vol. 17, no. 4, pp. 85–87 (in Russ.).
19. Kurbaniyazova V.E., Khudoyarova D.R. Realities of the time. Rehabilitation of women with a uterine scar. Vestnik nauki i obrazovaniya, 2020, no. 23 (101), pp. 72–78 (in Russ.).
20. Nozhnitseva O.N., Semenov I.A., Bezhenar’ V.F. Uterine scar after cesarean section and the optimal algorithm for diagnosing its condition. Luchevaya diagnostika i terapiya, 2019, no. 2 (10), pp. 85–90 (in Russ.).
21. Borovkov V.A., Cherkasova T.M., Pachkovskaya O.Yu., Safarova G.A., Gurevich N.L. Perinatal risk assessment in pregnant women with a uterine scar. Byulleten’ meditsinskoy nauki, 2019, no. 2 (14), pp. 50–55 (in Russ.).
22. Babkina T.M. Echographic research methods in obstetrics. Klinicheskaya meditsina, 2016, no. 3, pp. 56–62 (in Russ.).
23. Barashyan L.G., Lalayan R.S., Kaz’menkova E.M., Bondarenko N.Yu., Cherednichenko A.A., Kibishev Z.B. Morphological studies of the scar on the uterus during cesarean section. Ural’skiy nauchnyy vestnik, 2019, vol. 5, no. 3, pp. 12–15 (in Russ.).
24. Nozhnitseva O.N. Optimizatsiya diagnostiki i khirurgicheskogo lecheniya lokal’nogo istoncheniya rubtsa na matke posle operatsii kesareva secheniya: dis. …kand. med. nauk [Optimization of diagnostics and surgical treatment of local thinning of the scar on the uterus after cesarean section. Dis. PhD med. sciences]. Saint Petersburg, 2020. 142 p.
25. Kiselevich M.F., Kiselevich M.M. Akusherskie operatsii: uchebnoe posobie [Obstetric operations: a tutorial]. Belgorod: OOO “Epitsentr”, 2024. 84 p.
26. Klinicheskie rekomendatsii. “Posleoperatsionnyy rubets na matke, trebuyushchiy predostavleniya meditsinskoy pomoshchi materi vo vremya beremennosti, rodov i v poslerodovom periode” – 20242025-2026 (06.09.2024). Utverzhdeny Minzdravom RF [Clinical guidelines. «Postoperative scar on the uterus requiring medical care to the mother during pregnancy, childbirth and in the postpartum period» — 20242025-2026 (06.09.2024). Approved by the Ministry of Health of the Russian Federation].
27. 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.).
28. Alekseev S.M., Malushko A.V., Komlichenko E.V. et al. Patent no. 2840188 C1 Rossiyskaya Federatsiya, MPK A61B 17/42, A61B 17/04. Sposob vaginal’noy metroplastiki nesostoyatel’nogo rubtsa na matke posle operatsii kesareva secheniya: zayavl. 29.10.2024: opubl. 19.05.2025 [Patent No. 2840188 C1 Russian Federation, IPC A61B 17/42, A61B 17/04. Method of vaginal metroplasty of an incompetent uterine scar after cesarean section: declared 29.10.2024: published 19.05.2025].