EXPERIENCE OF USING PRP THERAPY FOR REPAIR SCAR ON THE UTERUS AFTER CESAREAN SECTION
Keywords:
uterine scar after cesarean section, platelet autoplasma, ultrasound, vascular DopplerAbstract
To evaluate the influence of platelet autoplasma administered intraoperatively on the processes of reparative regeneration and the formation of a full-fledged scar on the uterus after cesarean section. Material and methods. 116 women who underwent cesarean section (CS) were examined; the main group consisted of 45 women who were injected with platelet-derived autoplasma (PRP) during surgery after suturing the incision on the uterus; comparison group - 71 operated patients who did not undergo PRP. Ultrasound and Doppler measurements of blood flow in the vessels of the uterus were used to determine the condition of the suture. Results. In the main group, echographic signs allowed us to conclude that this type of suture has a better hemostatic effect. The use of PRP improves uterine involution after CS (p<0.05). 3 months after the operation, ultrasound in the main group revealed a slight thinning of the scar in only 2.2% of patients; in the control group, an incompetent scar was diagnosed in 11.3%.Conclusion. Intraoperative injection of platelet autoplasma into the area of sutures on the uterus has a positive effect on the healing of the uterine scar after cesarean section, allows for acceleration of the process of reparative regeneration, the formation of a full-fledged scar due to increased angiogenesis and improved vascularization.
References
Краснопольский В.И., Буянова С.Н., Щукина НА, Логутова Л.С. Несостоятельность шва (рубца) на матке после КС: проблемы и решения. //Росс. вестник акушера-гинеколога. 2015; 3:4-8. https://doi.org/10.17116/rosakush20151534-8
Макиян З.Н., Адамян Л.В., Карабач В.В., Чупрынин В.Д. Новый метод хирургического лечения несостоятельности рубца на матке после кесарева сечения с помощью внутриматочного манипулятора с желобом. //Акушерство и гинекология. 2020; 2: 104-10. https://dxdoi.org/1018565/aig.20202104-110.
Ciebiera M, Ciebiera M, Czekanska-Rawska M, Jakiel G. Laparoscopic isthmocele treatment - single center experience. // Videosurgery Minim Invasive Gynecol. 2017; 12:88-95. https://doi.org/10.5114/wiitm.2017.66025
Robson 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/mja16.00832
Satpathy G, Kumar I, Matah M, Verma A. Comparative accuracy of magnetic resonance morphometry and sonography in assessment of post-cesarean uterine scar. //Indian J. Radiol Imaging. 2018; 28:169-74. E mail: drdnv5@gmail.com
Seliger G, Chaoui K, Lautenschlager C et al. Technique of sonographic assessment of lower uterine segment in women with previous cesarean delivery: a prospective, pre/intraoperative comparative ultrasound study. // Arch. Gynecol. Obstet. 2018; 298: 297-306. DOI: 10.1007/s00404-018-4805-6
Setubal A, Alves J, Osorio F et al. Treatment for uterine isthmocele, a pouch-like defect at the site of cesarean section scar. // J. Minim. Invasive Gynecol. 2017. https://doi.org/doi.-10.1016lj.jmig2017.09022.
Tang X., Wang J., Du Yet al. Caesarean scar defect: Risk factors and comparison of evaluation efficacy between transvaginal sonography and magnetic resonance imaging. //Eur. J. Obstet Gynecol. Reprod. Biol. 2019; 242:1-6. DOI: 10.1016/j.ejogrb.2019.09.001
Tanimura 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; 41:1363-9. https://doi.org/10.1111/jog.12738
Tavukcu HH, Aytaç Ö, Atuğ F, Alev B, Çevik Ö, Bülbül N, Yarat A, Çetinel Ş, Şener G, Kulaksızoğlu H. Protective effect of platelet-rich plasma on urethral injury model of male rats. // Neurourol. Urodyn. 2018;37(4):1286‒1293. https://doi.org/10.1002/nau.23460.
Tulandi T, Cohen A. Emerging manifestations of Cesarean scar defect in reproductive-aged women. // J. Minim. Invasive Gynecol. 2016; 23:893-902. DOI: 10.1016/j.jmig.2016.06.020
Van der Voet LF, Jordans IP, Brolmann HA et al. Changes in the uterine scar during the first year after a caesarean section: a prospective longitudinal study. //Gynecol. Obstet. Invest. 2017. https://doi.10.1159/000478046
Zhang Y. A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous Cesarean scar defect. // J. Minim. Invasive Gynecol. 2016; 23:535-41. DOI: 10.1016/j.jmig.2016.01.007
