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Рубец на матке после кесарева сечения: терминологические аспекты
DOI: 10.26442/20795696.2020.5.200415
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Martynov S.A., Adamyan L.V. Cesarean scar defect: terminological aspects. Gynecology. 2020; 22 (5): 70–75. DOI: 10.26442/20795696.2020.5.200415
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Ключевые слова: несостоятельность рубца на матке, дефект рубца, ниша, истмоцеле, кесарево сечение.
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The review aim was to summarize information and to provide terminological analysis of the foreign and Russian literature on assessing the status of the uterine scar after a caesarean section, as well as to identify terms that are most appropriate to use out and during pregnancy, in childbirth and in the postpartum period.
Key words: inconsistency of uterine scar, scar defect, niche, isthmocele, cesarean section.
2. 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. DOI: 10.1016/j.jmig.2017.09.022
3. Краснопольский В.И., Буянова С.Н., Щукина Н.А., Логутова Л.С. Несостоятельность шва (рубца) на матке после КС: проблемы и решения (редакционная статья). Рос. вестник акушера-гинеколога. 2015; 3: 4–8.
[Krasnopol'skii V.I., Buianova S.N., Shchukina N.A., Logutova L.S. Nesostoiatel'nost' shva (rubtsa) na matke posle KS: problemy i resheniia (redaktsionnaia stat'ia). Ros. vestnik akushera-ginekologa. 2015; 3: 4–8 (in Russian).]
4. Poidevin LO. The value of hysterography in the prediction of cesarean section wound defects. Am J Obstet Gynecol 1961; 81: 67–71.
5. Burger NF, Darazs B, Boes EG. An echographic evaluation during the early puerperium of the uterine wound after caesarean section. J Clin Ultrasound 1982; 10: 271–4.
6. Chen HY, Chen SJ, Hsieh FJ. Observation of cesarean section scar by transvaginal ultrasonography. Ultrasound Med Biol 1990; 16: 443–7.
7. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the ‘niche’ in the scar. J Ultrasound Med 2001; 20: 1105–15.
8. Vervoort AJ, Vissers J, Hehenkamp WJ et al. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG 2018; 125: 317–25.
9. Vervoort AJ, Van der Voet LF, Hehenkamp WJ et al. Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial. BJOG 2018; 125: 326–34.
10. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ et al. Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30: 2695–702.
11. Van der Voet LF, Vervoort AJ, Veersema S et al. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG 2014; 121: 145–56.
12. Ofili-Yebovi D, Ben-Nagi J, Sawyer E et al. Deficient lower segment cesarean section scars: Prevalence and risk factors. Ultrasound Obstet Gynecol 2008; 31: 72–7.
13. Gubbini G, Casadio P, Marra E. Resectoscopic Correction of the "Isthmocele" in Women With Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility. J Min Invas Gynecol 2008; 15 (2): 172–5. DOI: 10.1016/j.jmig.2007.10.004
14. Raimondo G, Grifone G, Raimondo D et al. Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study. J Min Invas Gynecol 2015; 22: 297–301.
15. Sipahi S, Sasaki K, Miller C. The minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repair. Curr Opin Obstet Gynecol 2017; 29: 257–65. DOI: 10.1097/GCO.0000000000000380
16. Liu SJ, Lv W, Li W. Laparoscopic repair with hysteroscopy of cesarean scar diverticulum. J Obstet Gynaecol Res 2016; 42 (12): 1719–23.
17. Abacjew-Chmylko A, Wydra DG, Olszewska H. Hysteroscopy in the treatment of uterine cesarean section scar diverticulum: a systematic review. Adv Med Sci 2017; 62 (2): 230–9.
18. Chen Y, Chang Y, Yao S. Transvaginal management of cesarean scar section diverticulum: a novel surgical treatment. Med Sci Monit 2014; 20: 1395–9.
19. Vikhareva Osser O, Valentin L. Clinical importance of appearance of Cesarean hysterotomy scar at transvaginal ultrasonography in non-pregnant women. Obstet Gynecol 2011; 117: 525–32.
20. Tulandi T, Cohen A. Emerging manifestations of Cesarean scar defect in reproductive-aged women. J Min Invas Gynecol 2016; 23: 893–902.
21. Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009; 34: 90–7.
22. Schepker N, Garcia-Rocha GJ, Versen-Hoynck F et al. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women. Arch Gynecol Obstet 2014. DOI: 10.1007/s00404-014-3582-0
23. Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril 2017; 107: 289–96.
24. Osser OV, Jokubkiene L, Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35: 75–83.
25. Wong W, Fung WT. Magnetic resonance imaging in the evaluation of cesarean scar defect. Gynecol Minim Invasive Ther 2008; 7: 104–7.
26. Grace L, Nezhat A. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature. J Minim Invasive Gynecol 2016; 23 (5): 843. DOI: 10.1016/j.jmig.2016.01.030
27. Hayakawa H, Itakura A, Mitsui T et al. Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand 2006; 85 (4): 429–34.
28. Fabres C, Aviles G, De La Jara C et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med 2003; 22 (7): 695–700.
29. Roberge S, Boutin A, Chaillet N et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol 2012; 29 (6): 465–71.
30. Naji O, Abdallah Y, Bij De Vaate AJ et al. Standardized approach for imaging and measuring cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol 2012; 39: 252–9.
31. Kok N, Wiersma IC, Opmeer BC et al. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (2): 132–9.
32. Jastrow N, Vikhareva O et al. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture? Ultrasound Obstet Gynecol 2016; 47: 410–14.
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[Krasnopol'skaia K.V., Popov A.A., Chechneva M.A. et al. Pregravidarnaia metroplastika po povodu nesostoiatel'nogo rubtsa na matke posle kesareva secheniia: vliianie na estestvennuiu fertil'nost' i rezul'taty EKO. Problemy reproduktsii. 2015; 3: 56–62. DOI: 10.17116/repro201521356-62 (in Russian).]
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[Ishchenko A.I., Davydov A.I., Aleksandrov L.S. et al. Nesostoiatel'nost' rubtsa na matke posle kesareva secheniia. Vybor metoda khirurgicheskogo vmeshatel'stva. Voprosy ginekologii, akusherstva i perinatologii. 2018; 17 (4): 51–9. DOI: 10.20953/1726-1678-2018-4-51-59 (in Russian).]
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[Puchkova N.V. Nesostoiatel'nyi rubets na matke posle kesareva secheniia: diagnostika, taktika vedeniia, reproduktivnyi prognoz. Avtoref. dis. ... kand. med. nauk. Moscow, 2014 (in Russian).]
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[Buianova S.N., Puchkova N.V. Nesostoiatel'nyi rubets na matke posle kesareva secheniia: diagnostika, taktika vedeniia, reproduktivnyi prognoz. Ros. vestnik akushera-ginekologa. 2011; 4: 36–8 (in Russian).]
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[Buianova S.N., Shchukina N.A., Chechneva M.A. et al. Sovremennye metody diagnostiki nesostoiatel'nosti shvov ili rubtsa na matke posle kesareva secheniia. Ros. vestnik akushera-ginekologa. 2013; (1): 73–7 (in Russian).]
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[Pavlova T.Iu., Argunov V.A., Filippova R.D. Kliniko-morfologicheskie aspekty rubtsa na matke posle kesareva secheniia. Sib. med. zhurn. 2007; 22 (S2): 10–2 (in Russian).]
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[Kan N.E., Tiutiunnik V.L., Demura T.A., Kesova M.I. Osobennosti formirovaniia rubtsa na matke posle kesareva secheniia pri nedifferentsirovannoi displazii soedinitel'noi tkani. Akusherstvo i ginekologiia. 2015; 1: 93–7 (in Russian).]
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[Pekarev O.G., Starikov N.V., Mayborodin I.V. Influence of the lower segment suturing technique on scar formation after abdominal delivery. In: Actual problems of perinatology, obstetrics and gynecology: collection of scientific papers, dedicated to the 65th anniversary of the Department of Obstetrics and Gynecology of the Faculty of Medicine, NSMA. Novosibirsk, 2003; p. 101–4 (in Russian).]
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[Nozhnitseva O.N., Bezhenar' V.F. Kombinirovannyi sposob korrektsii lokal'noi nesostoiatel'nosti rubtsa na matke posle kesareva secheniia. Problemy reproduktsii. 2018; 24 (5): 45–52 (in Russian).]
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[Arakelyan A.S., Martynov S.A., Khoroshun N.D. et al. Diagnostics and surgical correction of uterine scar failure after CS using laparoscopy and hysteroscopy. In: Sukhikh G.T., Adamyan L.V. (ed.). Materials of the XXIX Congress “New technologies in the diagnosis and treatment of gynecological diseases”. Moscow, June 7–10, 2016. Moscow, 2016; p. 179–80 (in Russian).]
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1. 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.
2. 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. DOI: 10.1016/j.jmig.2017.09.022
3. Krasnopol'skii V.I., Buianova S.N., Shchukina N.A., Logutova L.S. Nesostoiatel'nost' shva (rubtsa) na matke posle KS: problemy i resheniia (redaktsionnaia stat'ia). Ros. vestnik akushera-ginekologa. 2015; 3: 4–8 (in Russian).
4. Poidevin LO. The value of hysterography in the prediction of cesarean section wound defects. Am J Obstet Gynecol 1961; 81: 67–71.
5. Burger NF, Darazs B, Boes EG. An echographic evaluation during the early puerperium of the uterine wound after caesarean section. J Clin Ultrasound 1982; 10: 271–4.
6. Chen HY, Chen SJ, Hsieh FJ. Observation of cesarean section scar by transvaginal ultrasonography. Ultrasound Med Biol 1990; 16: 443–7.
7. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the ‘niche’ in the scar. J Ultrasound Med 2001; 20: 1105–15.
8. Vervoort AJ, Vissers J, Hehenkamp WJ et al. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG 2018; 125: 317–25.
9. Vervoort AJ, Van der Voet LF, Hehenkamp WJ et al. Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial. BJOG 2018; 125: 326–34.
10. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ et al. Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30: 2695–702.
11. Van der Voet LF, Vervoort AJ, Veersema S et al. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG 2014; 121: 145–56.
12. Ofili-Yebovi D, Ben-Nagi J, Sawyer E et al. Deficient lower segment cesarean section scars: Prevalence and risk factors. Ultrasound Obstet Gynecol 2008; 31: 72–7.
13. Gubbini G, Casadio P, Marra E. Resectoscopic Correction of the "Isthmocele" in Women With Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility. J Min Invas Gynecol 2008; 15 (2): 172–5. DOI: 10.1016/j.jmig.2007.10.004
14. Raimondo G, Grifone G, Raimondo D et al. Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study. J Min Invas Gynecol 2015; 22: 297–301.
15. Sipahi S, Sasaki K, Miller C. The minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repair. Curr Opin Obstet Gynecol 2017; 29: 257–65. DOI: 10.1097/GCO.0000000000000380
16. Liu SJ, Lv W, Li W. Laparoscopic repair with hysteroscopy of cesarean scar diverticulum. J Obstet Gynaecol Res 2016; 42 (12): 1719–23.
17. Abacjew-Chmylko A, Wydra DG, Olszewska H. Hysteroscopy in the treatment of uterine cesarean section scar diverticulum: a systematic review. Adv Med Sci 2017; 62 (2): 230–9.
18. Chen Y, Chang Y, Yao S. Transvaginal management of cesarean scar section diverticulum: a novel surgical treatment. Med Sci Monit 2014; 20: 1395–9.
19. Vikhareva Osser O, Valentin L. Clinical importance of appearance of Cesarean hysterotomy scar at transvaginal ultrasonography in non-pregnant women. Obstet Gynecol 2011; 117: 525–32.
20. Tulandi T, Cohen A. Emerging manifestations of Cesarean scar defect in reproductive-aged women. J Min Invas Gynecol 2016; 23: 893–902.
21. Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009; 34: 90–7.
22. Schepker N, Garcia-Rocha GJ, Versen-Hoynck F et al. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women. Arch Gynecol Obstet 2014. DOI: 10.1007/s00404-014-3582-0
23. Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril 2017; 107: 289–96.
24. Osser OV, Jokubkiene L, Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35: 75–83.
25. Wong W, Fung WT. Magnetic resonance imaging in the evaluation of cesarean scar defect. Gynecol Minim Invasive Ther 2008; 7: 104–7.
26. Grace L, Nezhat A. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature. J Minim Invasive Gynecol 2016; 23 (5): 843. DOI: 10.1016/j.jmig.2016.01.030
27. Hayakawa H, Itakura A, Mitsui T et al. Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand 2006; 85 (4): 429–34.
28. Fabres C, Aviles G, De La Jara C et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med 2003; 22 (7): 695–700.
29. Roberge S, Boutin A, Chaillet N et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol 2012; 29 (6): 465–71.
30. Naji O, Abdallah Y, Bij De Vaate AJ et al. Standardized approach for imaging and measuring cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol 2012; 39: 252–9.
31. Kok N, Wiersma IC, Opmeer BC et al. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (2): 132–9.
32. Jastrow N, Vikhareva O et al. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture? Ultrasound Obstet Gynecol 2016; 47: 410–14.
33. Krasnopol'skaia K.V., Popov A.A., Chechneva M.A. et al. Pregravidarnaia metroplastika po povodu nesostoiatel'nogo rubtsa na matke posle kesareva secheniia: vliianie na estestvennuiu fertil'nost' i rezul'taty EKO. Problemy reproduktsii. 2015; 3: 56–62. DOI: 10.17116/repro201521356-62 (in Russian).
34. Ishchenko A.I., Davydov A.I., Aleksandrov L.S. et al. Nesostoiatel'nost' rubtsa na matke posle kesareva secheniia. Vybor metoda khirurgicheskogo vmeshatel'stva. Voprosy ginekologii, akusherstva i perinatologii. 2018; 17 (4): 51–9. DOI: 10.20953/1726-1678-2018-4-51-59 (in Russian).
35. Puchkova N.V. Nesostoiatel'nyi rubets na matke posle kesareva secheniia: diagnostika, taktika vedeniia, reproduktivnyi prognoz. Avtoref. dis. ... kand. med. nauk. Moscow, 2014 (in Russian).
36. Buianova S.N., Puchkova N.V. Nesostoiatel'nyi rubets na matke posle kesareva secheniia: diagnostika, taktika vedeniia, reproduktivnyi prognoz. Ros. vestnik akushera-ginekologa. 2011; 4: 36–8 (in Russian).
37. Buianova S.N., Shchukina N.A., Chechneva M.A. et al. Sovremennye metody diagnostiki nesostoiatel'nosti shvov ili rubtsa na matke posle kesareva secheniia. Ros. vestnik akushera-ginekologa. 2013; (1): 73–7 (in Russian).
38. Pavlova T.Iu., Argunov V.A., Filippova R.D. Kliniko-morfologicheskie aspekty rubtsa na matke posle kesareva secheniia. Sib. med. zhurn. 2007; 22 (S2): 10–2 (in Russian).
39. Kan N.E., Tiutiunnik V.L., Demura T.A., Kesova M.I. Osobennosti formirovaniia rubtsa na matke posle kesareva secheniia pri nedifferentsirovannoi displazii soedinitel'noi tkani. Akusherstvo i ginekologiia. 2015; 1: 93–7 (in Russian).
40. Pekarev O.G., Starikov N.V., Mayborodin I.V. Influence of the lower segment suturing technique on scar formation after abdominal delivery. In: Actual problems of perinatology, obstetrics and gynecology: collection of scientific papers, dedicated to the 65th anniversary of the Department of Obstetrics and Gynecology of the Faculty of Medicine, NSMA. Novosibirsk, 2003; p. 101–4 (in Russian).
41. Persianinov L.S. et al. Guide to obstetrics and gynecology. In 6 vol. Moscow: Medgiz, 1961–1964 (in Russian).
42. Repina M.A. Rupture of the uterus. Leningrad: Medicine, 1984 (in Russian).
43. Savelyeva G.M. Obstetrics. Moscow: Medicine, 2000 (in Russian).
44. Nozhnitseva O.N., Bezhenar' V.F. Kombinirovannyi sposob korrektsii lokal'noi nesostoiatel'nosti rubtsa na matke posle kesareva secheniia. Problemy reproduktsii. 2018; 24 (5): 45–52 (in Russian).
45. Arakelyan A.S., Martynov S.A., Khoroshun N.D. et al. Diagnostics and surgical correction of uterine scar failure after CS using laparoscopy and hysteroscopy. In: Sukhikh G.T., Adamyan L.V. (ed.). Materials of the XXIX Congress “New technologies in the diagnosis and treatment of gynecological diseases”. Moscow, June 7–10, 2016. Moscow, 2016; p. 179–80 (in Russian).
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ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия
*s_martynov@oparina4.ru
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Sergei A. Martynov*, Leila V. Adamian
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*s_martynov@oparina4.ru