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Shchepelev M.E., Deripasko T.V., Sidorova А.А., Drandrova E.G., Moskvichev E.V., Leonteva T.Yu., Afanasev D.A.
A Clinical Case of an Undeveloped Pregnancy in a Uterine Scar After a Cesarean Section
Keywords: pregnancy in the uterine scar, ectopic pregnancy, cesarean section, undeveloped pregnancy
Over the past twenty-five years, the average age of a woman giving birth to the first child has grown significantly around the world. So, in Russia, currently, women begin to bring their reproductive function into action on average at the age of 26-35. This leads to the fact that obstetricians and gynecologists in their practice increasingly face with pregnancy and childbirth complicated by a uterine scar after a previous cesarean section or myomectomy. The formation of a uterine scar after any intervention entails the likelihood of long-term complications, such as a rupture of the uterus along the scar and pregnancy in the uterine scar. According to the latest clinical recommendations for ectopic pregnancy, pregnancy in the uterine scar has been added to the anatomical classification of ectopic pregnancies. The article describes a clinical case of an undeveloped pregnancy in the uterine scar after a cesarean section, it shows the difficulty of timely diagnosis of such pregnancy, which often results in improper management of patients and loss of fertility by women of childbearing age. In the described case, late diagnosis of pregnancy in the uterine scar necessitated organ-resecting surgery – extirpation of the uterus with fallopian tubes.
References
- Blagina E.I. Prichiny formirovaniya nesostoyatel’nogo rubtsa na matke posle kesareva secheniya i metody profilaktiki: avtoref. dis. … kand. med. nauk [Causes of the formation of an untenable scar on the uterus after cesarean section and methods of prevention. Abstract of Cand. Diss.]. Moscow, 2017, 22 p.
- Garaeva A.S. Nekotorye osobennosti reproduktivnykh ustanovok zhenshchin starshikh vozrastnykh grupp Chechenskoi respubliki [Some features of the reproductive systems of women of older age groups chechen republic]. Klinicheskaya gerontologiya, 2016, no. 7-8, pp. 66–69.
- Ivshin A.A., Ivshina P.V. Kesarevo sechenie: paradigma bezopasnosti [Cesarean section: paradigm of security]. Vestnik nauki i obrazovaniya, 2017, no. 12(36), pp. 100–102.
- Kesova M.I., Bolotova O.V., Kan N.E., Ordzhonikidze N.V. Prognosticheskie kriterii otsenki sostoyaniya rubtsa na matke posle kesareva secheniya [Prognostic criteria of the cesarean scar status appraisal]. Vestnik RUDN. Ser. Meditsina, 2009, no. 5, pp. 175–180.
- Klinicheskie rekomendatsii (protokol lecheniya) «Vnematochnaya (ektopicheskaya) beremennost’», utverzhdennye Minzdravom Rossii i ROAG ot 6 fevralya 2017 g. [Clinical guidance (protocol of treatment) “Ectopic pregnancy”, approved by Ministry of Healthservice of Russian Federation and Russian Society of Obstetricians-Gynecologists on February 6, 2017], no. 15-4/10/2-729, 35 p.
- Klinicheskie rekomendatsii (protokol lecheniya) «Kesarevo sechenie. Pokazaniya, metody obezbolivaniya, khirurgicheskaya tekhnika, antibiotikoprofilaktika, vedenie posleoperatsionnogo perioda» (utv. Prezidentom Rossiiskogo obshchestva akusherov-ginekologov) ot 6 maya 2014 g. [Clinical guidance (protocol of treatment) “Cesarean section. Indications, methods of anesthesia, surgical technique, antibiotic prophylaxis, management of postoperative period” (approved by the President of Russian Society of Obstetricians-Gynecologists on May 6, 2014)], no. 15-4/10/2-3190, 44 p.
- Kogan O.M., Voitenko N.B., Zosimova E.A., Martynova E.N., Nersesyan D.M., Bubnikovich A.A. Algoritm vedeniya patsientok s nesostoyatel’nost’yu posleoperatsionnogo rubtsa na matke posle kesareva secheniya [Algorithm for the management of patients with incompetence of postoperative uterine scar after a cesarean section]. Klinicheskaya praktika, 2018, no. 3, pp. 38–43.
- Polyanin D.V., Mikhel’son A.A., Melkozerova O.A., Luk’yanova K.D. Diskussionnye voprosy nesostoyatel’nosti rubtsa na matke v eru epidemii kesareva secheniya [Discussion issues of incompetent uterine scar in the era of the caesarian section epidemic]. Ural’skii meditsinskii zhurnal, 2019, no. 5(173), pp. 17–23.
- Popov A.A., Fedorov A.A., Vrotskaya V.S., Manannikova T.N., Tyurina S.S., Koval’ A.A., Chechneva M.A., Logutova L.S. Endoskopicheskie metody diagnostiki i khirurgicheskoi korrektsii nesostoyatel’nogo rubtsa na matke posle kesareva secheniya [Endoscopic diagnosis and surgical correction of the insolvent uterine scar after cesarean section]. Akusherstvo i Ginekologiya Sankt-Peterburga, 2017, no. 1, pp. 54–57.
- Rybalka A.N., Sulima A.N., Beglitse D.A., Mitrofanova O.A., Latyshev O.S., Kolesnikova I.O. Klinicheskii sluchai ektopicheskoi beremennosti v rubtse na matke posle operatsii kesareva secheniya [Ectopic pregnancy in the uterus scar left after cesarean section: a clinical case]. Akusherstvo, ginekologiya i reproduktsiya, 2018, no. 12(2), pp. 69–75. DOI: 10.17749/2313-7347.2018.12.2.069-075.
- Sidorov A.E., Gunin A.G., Chernyshov V.V. Otdalennye riski kesareva secheniya: beremennost’ v rubtse na matke. Obzor literatury [Long-term risks of cesarean delivery: cesarean scar pregnancy. A systematic review]. Akusherstvo, ginekologiya i reproduktsiya, 2017, no. 11(4), pp. 48–56. DOI: 10.17749/2313-7947.2017.11.4.048-056.
- Sidorov A.E., Sidorov E.S., Samoilova A.V., Gunin A.G., Deripasko T.V., Chernyshov V.V., Prokop’ev I.I., Maiorov V.S. Beremennost’ v rubtse na matke posle kesareva secheniya [Pregnancy in uterine scar after cesarean section]. Zdravookhranenie Chuvashii, 2014, no. 3, pp. 49–56.
- Sul’dyaikina N.V. Otnoshenie zhenshchin k pozdnemu detorozhdeniyu i materinstvu [Later childbearing as a social phenomenon]. Ogarev-Online, 2017, no. 5(94). Available at: http://journal.mrsu.ru/arts/otnoshenie-zhenshhin-k-pozdnemu-detorozhdeniyu-i-materinstvu.
- Stanoevich I.V. Diskussionnye aspekty fiziologii zhenskoi reproduktivnoi sistemy: meditsinskaya i demograficheskaya problemy [Debatable aspects of the physiology of the female reproductive system: a medical and demographic problem]. Rossiiskii vestnik akushera-ginekologa, 2012, no. 12(2), pp. 73–77.
- Terebneva L.A. Istoriya testov na beremennost’ i sovremennye sposoby opredeleniya beremennosti malogo sroka [Pregnancy tests history and modern methods of determining early pregnancy]. Ginekologiya, 2015, no. 17(2), pp. 50–54.
- Matthews T.J., Hamilton B.E. First births to older women continue to rise. NCHS Data Brief, 2014, vol. 152, pp. 1–8.
- Memtsa M., Jurkovic D. Intramural Pregnancy. In: Tulandi T., eds. Ectopic Pregnancy. Springer, Cham., 2015. DOI: https://doi.org/10.1007/978-3-319-11140-7.
- Paul P.G., Mannur S., Shintre H., Paul G., Gulati G. Myomectomy scar pregnancy: a rare complication of myomectomy. Gynecol Surg., 2018, vol. 34, pp. 53–57.
- Tagore S., Teo S.H., Chua S.Y., Ong C.L., Kwek Y.C. A retrospective review of uterine scar pregnancies: single centre experience. Arch Gynecol Obstet., 2010, vol. 282, pp. 711–715.
- Wong K.S., Tan J., Ang C., Ngu A. Myomectomy scar ectopic pregnancy. Aust N Z J Obstet Gynaecol., 2010, vol. 50(1), pp. 93–94. DOI: 10.1111/j.1479-828X.2009.01121.x.
About authors
- Shchepelev Mikhail E.
- Candidate of Medical Sciences, Head of Gynecology Department no. 1, Emergency Hospital, Russia, Cheboksary (shch-1962@mail.ru; ORCID: https://orcid.org/0000-0003-2431-9254)
- Deripasko Tatyana V.
- Chief Freelance Specialist in Obstetrics and Gynecology of Health Ministry of Chuvash Republic, Head of Obstetrical Distance Consulting Center – Obstetrician-Gynecologist, Presidential Perinatal Center, Russia, Cheboksary (ppc@med.cap.ru; ORCID: https://orcid.org/0000-0002-6824-9633)
- Sidorova Anastasiya A.
- Resident of the 1st year of Faculty and Hospital Therapy Department, Chuvash State University, Russia, Cheboksary (far.anastasiya@yandex.ru; ORCID: https://orcid.org/0000-0001-6559-8267)
- Drandrova Elena G.
- Obstetrician-Gynecologist of Gynecology Department no. 1, Emergency Hospital; Candidate of Medical Sciences, Associate Professor, Department of Normal and Topographic Anatomy with Operative Surgery, Chuvash State University, Russia, Cheboksary (drandrov@yandex.ru; ORCID: https://orcid.org/0000-0003-3341-3373)
- Moskvichev Evgeny V.
- Doctor of Medical Sciences, Professor, Department of Normal and Topographic Anatomy with Operative Surgery, Chuvash State University, Russia, Cheboksary (Moskvichev@rambler.ru; ORCID: https://orcid.org/0000-0002-2850-5487)
- Leonteva Tatyana Yu.
- Obstetrician-Gynecologist of Gynecology Department no. 1, Emergency Hospital, Russia, Cheboksary (leo.tani@yandex.ru; ORCID: https://orcid.org/0000-0003-2591-2447)
- Afanasev Denis A.
- Obstetrician-Gynecologist of Gynecology Department no. 1, Emergency Hospital, Russia, Cheboksary (bsmp@med.cap.ru; ORCID: https://orcid.org/0000-0003-4270-8018)
Article link
Shchepelev M.E., Deripasko T.V., Sidorova А.А., Drandrova E.G., Moskvichev E.V., Leonteva T.Yu., Afanasev D.A. A Clinical Case of an Undeveloped Pregnancy in a Uterine Scar After a Cesarean Section [Electronic resource] // Acta medica Eurasica. – 2021. – №3. P. 26-34. – URL: https://acta-medica-eurasica.ru/en/single/2021/3/4/. DOI: 10.47026/2413-4864-2021-3-26-34.