Акушерство и Гинекология Санкт-Петербурга. 2017; : 14-17
Современный взгляд на проблему развития несостоятельных рубцов после операции кесарева сечения
Аннотация
В последние десятилетия стало известно о существовании таких отдаленных осложнений кесарева сечения, как постменструальные кровотечения, дисменорея, хроническая тазовая боль, диспареуния, бесплодие. Было высказано предположение, что эти симптомы могут быть связаны с неполным заращением рубца на матке, который также называется "ниша". Проведя анализ литературы, можно разделить факторы, приводящие к развитию несостоятельности рубца, на 4 основные группы: факторы, связанные с техникой ушивания; факторы, связанные с развитием нижнего сегмента матки или уровня разреза матки; хирургическая деятельность, которая может индуцировать образование спаек и как следствие вызвать ухудшение заживления ран; факторы возможного негативного влияния (возможно связанные с заживлением ран). Необходимо дальнейшее изучение этой проблемы для установления истинной причины образования несостоятельных рубцов, а именно влияние каждого фактора на этот процесс.
Список литературы
1. Barros A.J., Santos I.S., Matijasevich A., Domingues M.R., Silveira M., Barros F.C., Victora C.G. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica. 2011; 45(4):635–43.
2. Deng W., Klemetti R., Long Q., Wu Z., Duan C., Zhang W.H., Ronsmans C., Zhang Y., Hemminki E. Cesarean section in Shanghai: women’s or healthcare provider’s preferences? BMC Pregnancy Childbirth. 2014; 14:285. doi: 10.1186/1471-2393-14-285.
3. Feng X.L., Wang Y., An L., Ronsmans C. Cesarean section in the People’s Republic of China: current perspectives. Int J Womens Health 2014; 6:59–4. doi: 10.2147/IJWH.S41410.
4. Osterman M.J., Martin J.A. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006–012. Natl Vital Stat Rep 2014; 63 (1):1–1.
5. Tower A.M., Frishman G.N. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013;20 (5):562–72. doi: 10.1016/j.jmig. 2013.03.008.
6. Gurol-Urganci I., Bou-Antoun S., Lim C.P., Cromwell D.A., Mahmood T.A., Templeton A., van der Meulen J.H. Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod 2013; 28 (7):19431952. doi: 10.1093/humrep/det130.
7. Ito M., Nawa T., Mikamo H., Tamaya T. Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after previous cesarean delivery. J Med. 1998; 29 (1-2):85–1.
8. Caesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG 2010;117 (1):1366–376. doi: 10.1111/j.1471-0528.2010.02686.x.
9. CORONIS Trial Collaborative Group. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial, BMC Pregnancy and Childbirth. 2007; 7:24. doi: 10.1186/1471-2393-7-24.
10. Osser O.V., Jokubkiene L., Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35 (1):75–3. doi: 10.1002/ uog.7496.
11. Zimmer E.Z., Bardin R., Tamir A., Bronshtein M. Sonographic imaging of cervical scars after Cesarean section. Ultrasound Obstet Gynecol. 2004; 23 (6):594– 598. DOI: 10.1002/uog.1033 12.
12. Cheong Y.C., Premkumar G., Metwally M., Peacock J.L., Li T.C. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol 2009; 147 (1):3–. doi: 10.1016/j.ejogrb.2009.06.003.
13. Казарян Р.М., Апресян С.В., Оразмурадов А.А., Князев С.А. Генетические и морфологические особенности рубца на матке после кесарева сечения. Вестник РУДН. Cерия Медицина. 2008; 1:12-16.
Obstetrics and Gynaecology of Saint-Petersburg. 2017; : 14-17
Modern view on the problem of development of the insolvent uterine scars after cesarean section
Abstract
In recent decades, it became known about the existence of suchdistant complications of cesarean section, like postmenstrual bleeding,dysmenorrhea, chronic pelvic pain, dyspareunia, infertility. It has beensuggested that these symptoms may be associated with incompletescarring on the uterus, which is also called a “niche”. After analyzing theliterature, it is possible to separate the factors leading to the developmentof the insolvent uterine scar into 4 main groups: factors related to thetechnique of suturing; factors associated with the development of thelower segment of the uterus or the level of the incision of the uterus;surgical activity that can induce the formation of adhesions and, as aconsequence, cause deterioration of wound healing; factors of possiblenegative effects (possibly associated with wound healing). Further studyof this problem is necessary to establish the true cause of the formationof insolvent scars, namely the influence of each factor on this process.
References
1. Barros A.J., Santos I.S., Matijasevich A., Domingues M.R., Silveira M., Barros F.C., Victora C.G. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica. 2011; 45(4):635–43.
2. Deng W., Klemetti R., Long Q., Wu Z., Duan C., Zhang W.H., Ronsmans C., Zhang Y., Hemminki E. Cesarean section in Shanghai: women’s or healthcare provider’s preferences? BMC Pregnancy Childbirth. 2014; 14:285. doi: 10.1186/1471-2393-14-285.
3. Feng X.L., Wang Y., An L., Ronsmans C. Cesarean section in the People’s Republic of China: current perspectives. Int J Womens Health 2014; 6:59–4. doi: 10.2147/IJWH.S41410.
4. Osterman M.J., Martin J.A. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006–012. Natl Vital Stat Rep 2014; 63 (1):1–1.
5. Tower A.M., Frishman G.N. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013;20 (5):562–72. doi: 10.1016/j.jmig. 2013.03.008.
6. Gurol-Urganci I., Bou-Antoun S., Lim C.P., Cromwell D.A., Mahmood T.A., Templeton A., van der Meulen J.H. Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod 2013; 28 (7):19431952. doi: 10.1093/humrep/det130.
7. Ito M., Nawa T., Mikamo H., Tamaya T. Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after previous cesarean delivery. J Med. 1998; 29 (1-2):85–1.
8. Caesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG 2010;117 (1):1366–376. doi: 10.1111/j.1471-0528.2010.02686.x.
9. CORONIS Trial Collaborative Group. The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial, BMC Pregnancy and Childbirth. 2007; 7:24. doi: 10.1186/1471-2393-7-24.
10. Osser O.V., Jokubkiene L., Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35 (1):75–3. doi: 10.1002/ uog.7496.
11. Zimmer E.Z., Bardin R., Tamir A., Bronshtein M. Sonographic imaging of cervical scars after Cesarean section. Ultrasound Obstet Gynecol. 2004; 23 (6):594– 598. DOI: 10.1002/uog.1033 12.
12. Cheong Y.C., Premkumar G., Metwally M., Peacock J.L., Li T.C. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol 2009; 147 (1):3–. doi: 10.1016/j.ejogrb.2009.06.003.
13. Kazaryan R.M., Apresyan S.V., Orazmuradov A.A., Knyazev S.A. Geneticheskie i morfologicheskie osobennosti rubtsa na matke posle kesareva secheniya. Vestnik RUDN. Ceriya Meditsina. 2008; 1:12-16.
