A Device for Diagnosis of Uterine Scar Integrity in the Early Postpartum Period
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A Device for Diagnosis of Uterine Scar Integrity in the Early Postpartum Period M. N. Mochalova, V. A. Mudrov*, and A. Yu. Mironenko
An experimental model of an original device for the diagnosis of uterine scar integrity in the early postpartum period is described. The design of the device is described, along with methods of assessing uterine scar integrity in the early postpartum period; the effectiveness of using this device for the diagnosis of defects is assessed in an experimental model. The diagnostic accuracy of the device is compared with that of manual examination of the uterine cavity.
Introduction An increase in the frequency of abdominal delivery with reconstructive plastic surgery associated with organ preserving surgery for uterine myomas and congenital anomalies of the reproductive system has led to an increase in the number of women with uterine scars who plan their pregnancy. Delivery in women with uterine scars via the natural birth canal is safer than repeated abdominal delivery [1]. The incidence of intraoperative complications in repeat Caesarian section is 20.5%, which is five times higher than the incidence associated with primary surgical delivery [2]. Caesarian section is the most important risk factor for postpartum infections, leading to an increase by factors of 520. In addition, it can be accompanied by thrombotic complications, as well as damage to the abdominal organs [3]. Maternal mortal ity associated with abdominal delivery is four times high er than for all types of vaginal delivery [4]. Thus, there is a need for qualitative diagnosis of the integrity of uterine scars in the early postpartum period. The concept of integrity in this period is defined as the absence of a defect at the scar site. Clinics in the Russian Federation assess uterine scar integrity in the early postpartum period by manual exam ination of the uterine cavity [5]. This procedure involves palpation of the integrity of the scar site. Wearing medical Chita State Medical Academy, Ministry of Heath of the Russian Federation, Chita, Russia; Email: [email protected] * To whom correspondence should be addressed.
gloves decreases tactile sensitivity, which can lead to diagnostic errors. In addition, the procedure is linked with the risk of complications associated with anesthesia [6]. Assessment of uterine scar integrity using ultrasound investigations is associated with a high frequency of false positive and false negative results: indications that a defect is present when it is not (24% of cases) and failure to detect a defect when present (43% of cases) [7]. The inaccuracy of this method in the early postpartum period is caused by reduced quality of echographic visualization due to interference resulting from uterine contractile activity and insufficient filling of the urinary bladder [8, 9]. A hysteroscope can be used to visualize the inner sur face of the uterine cavity. In contrast to the use of the device described here, hysteroscopy involves delivery of liquid directly into the uterine cavity [10
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