Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

Abstract

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.

Meta‐analysis comparing different ultrasound detection methods to accurately assess wound healing and scar formation after caesarean section

“…Similarly, the discussion of scar formation, where TU demonstrated superior outcomes, aligns with emerging discussions about the long‐term implications of caesarean wound management 19 . Scar tissue, beyond its aesthetic concerns, has profound implications for uterine health and future pregnancies, underscoring the need for detailed understanding and monitoring, which TU appears to provide better than CU 20,21 …”

“…19 Scar tissue, beyond its aesthetic concerns, has profound implications for uterine health and future pregnancies, underscoring the need for detailed understanding and monitoring, which TU appears to provide better than CU. 20,21 The clinical implications of these findings are vast, suggesting a pivot towards more extensive integration of TU into post-caesarean care protocols, especially for twin pregnancies. 22 However, this transition is not without its challenges.…”

Bioactive Injectable and Self‐Healing Hydrogel Via Cell‐Free Fat Extract for Endometrial Regeneration

“…In PBS solution, the Cu-PEG and CF@Cu-PEG hydrogels could maintain at least 10 days while HA only keep solid for 4 days (Figure 3E) suggesting Cu-PEG and CF@Cu-PEG hydrogels would effectively inhibit the formation of adhesion as the fibrosis was initiated 3-10 days later after injury. [42,43] The system could be degraded in about 10 days after discharge from the reproductive tract and reduce the body rejection without surgery to remove [44] and it also ensured the safety of embryo implantation in the next menstrual cycle. In addition, copper ions have inhibitory effects on a variety of pathogens (such as bacteria, fungi, and viruses).…”

Prediction of Scar Myometrium Thickness and Previous Cesarean Scar Defect Using the Three‐Dimensional Vaginal Ultrasound

“…After cesarean section, the wound will heal and produce uterine scar, but poor healing will produce previous cesarean scar defect (PCSD) [ 9 ]. Poor wound healing leads to thinning of the muscle layer at the uterine scar, forming a depression or lacuna that communicates with the uterine cavity [ 10 , 11 ]. The causes of PCSD can be divided into two sources: one is caused by congenital defect or abnormal embryo development; the second is caused by acquired external factors, among which the poor healing effect of the myometrium after cesarean section is the main reason [ 12 ].…”