Issue: 2023, Vol. 28, No. 1

А. М. Gerassimov, D. А. Мalyshkina, А. V. Smirnova, А. I. Мalyshkina, D. I. Мilovanova, А. А. Prusova, А. S. Кisselyova

CLINICAL AND ANAMNESTIC FEATURES OF ENDOMETRIOSIS OF SURGICAL SCAR

Keywords

scar endometriosis, Caesarean section, risk factors for the development of endometriosis of surgical scar.

Abstarct

ABSTRACT Endometriosis of surgical scar (ESS) is one of rare localizations of extragenital endometriosis. Objective – to present clinical and anamnestic description and to evaluate the peculiarities of previous pregnancy course and operative childbirth in patients with ESS after Caesarean section (CS). Material and methods. The survey was performed in gynecological clinic of Federal State Budgetary Institution “Ivanovo Research Institute of Maternity&Childhood by V.I.Gorodkov” of the Ministry of Health of the Russian Federation. 68 cases of ESS were analyzed on average in 3,7 ± 0,4 years after CS. Results and discussion. In general patients complained of pain which were connected with cycle or constant pain. In 82,4 % cases the formation in the zone of surgical scar was revealed by palpation. By ultrasound examination average sizes of endometrioid heterotropy were amounting to 10401,5 ± 2102,9 mm 3 . In the anamnesis inflammatory diseases of reproductive system were registered in 27,3 % patients, small uterine myoma - in 13,6 %, endometrium hyperplasia without atypia - in 4,5 %, functional ovarian cysts - in 15,9 %. Histologically verified external genital endometriosis was registered in 4,4 % cases only. Before ESS development patients had on average 2,2 ± 0,2 pregnancies. The most part of women (77,3 %) underwent different surgical interventions before pregnancy. The pregnancy preceding the occurrence of cicatricial endometriosis was complicated by placental insufficiency in 35,3 % cases (with decompensation – in 17,6 %), preeclampsia – in 41,17 %, hestation hypertension – in 14,7 %, fetal development delay syndrome – in 17,6 %. In 28,4 % patients delivery was carried out before the full 37 weeks of pregnancy. Conclusion. The obtained data testified to the fact that ESS was purely iatrogenic disease, and its pathogenesis was not directly connected with classic endometriosis and had own specific risk factors such as surgical interventions (abdominal and endoscopic) before CS, hypertensive disorders during pregnancy, early delivery.

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• Vestnik_1_2023-17-23