mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2025-16-2-29-36mvjr-1973Research Article3.1.4. АКУШЕРСТВО И ГИНЕКОЛОГИЯ3.1.4. OBSTETRICS AND GYNECOLOGYКлинико-анамнестические факторы риска формирования несостоятельного рубца после одной операции кесарева сеченияClinical and anamnestic risk factors for the formation of an incompetent scar after one cesarean sectionhttps://orcid.org/0000-0002-8810-1505КурочкаМ. П.KurochkaM. P.

Курочка Марина Петровна, д.м.н., доцент кафедры акушерства и гинекологии №1 

Ростов-на-Дону 

Marina P. Kurochka, Doctor of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology No. 1 

Rostov-on-Don 

marina-kurochka@yandex.ruhttps://orcid.org/0009-0002-0746-0555ПелогеинаЕ. И.PelogeinaE. I.

Пелогеина Евгения Игоревна, аспирант 4-го года обучения кафедры акушерства и гинекологии №1 

Ростов-на-Дону 

Evgenia I. Pelogeina, 4th year graduate student of the Department of Obstetrics and Gynecology No. 1 

Rostov-on-Don 

epiii05@mail.ruhttps://orcid.org/0000-0002-7445-8319ЗабозлаевФ. Г.ZabozlaevF. G.

Забозлаев Федор Георгиевич, главный специалист по патологической анатомии ФМБА России, заведующий патологоанатомическим отделением  

 Москва 

Fedor G. Zabozlaev, chief specialist in pathological anatomy of the FMBA of Russia. Head of the pathological department 

 Moscow 

fzab@mail.ruhttps://orcid.org/0000-0001-7066-3166МаркинаВ. В.MarkinaV. V.

Маркина Валентина Владимировна, к.м.н, доцент кафедры акушерства и гинекологии №1 

Ростов-на-Дону 

Valentina V. Markina, Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology No. 1 

Rostov-on-Don 

Ростовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationФедеральный научно-клинический центр Федерального медико-биологического агентства РоссииРоссияFederal Scientific and Clinical Center of the Federal Medical and Biological Agency of RussiaRussian Federation2025020720251622936Copyright © Курочка М.П., Пелогеина Е.И., Забозлаев Ф.Г., Маркина В.В., 20252025Курочка М.П., Пелогеина Е.И., Забозлаев Ф.Г., Маркина В.В.Kurochka M.P., Pelogeina E.I., Zabozlaev F.G., Markina V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1973

Цель: определение клинико-анамнестических факторов риска, формирования несостоятельного рубца на матке у пациенток после одной предыдущей операции кесарева сечения. Материалы и методы: 102 истории пациенток с рубцом на матке после одного кесарева сечения, 102 карты новорождённых, результаты патоморфологических исследований последов за 2019–2020 гг. Все пациентки были разделены на три группы: I группа (контрольная) — 35 женщин с рубцом на матке, родивших вагинально; II группа (основная А) — 35 пациенток с установленной несостоятельностью рубца после одного КС до родов; III группа (основная В) — 32 пациентки с неудачной попыткой вагинальных родов и установленной интраоперационно несостоятельностью рубца на матке после одного КС. Результаты: установлено, что несостоятельный рубец на матке связан с внутриматочными вмешательствами на органах малого таза (р1,2=0,031, ОШ1,2=2,864; 95%ДИ=1,086-7,552), которые статистически значимо чаще встречались во II группе по сравнению с I группой. Воспалительные заболевания органов малого таза (ВЗОМТ) в анамнезе встречались статистически значимо чаще во II группе по сравнению с I группой (р1,2=0,012, ОШ1,2=3,778; 95%ДИ=1,308-10,913). В III группе с неудачной попыткой вагинальных родов генитальный эндометриоз встречался высокостатистически значимо чаще по сравнению с I и II группами исследования (р1,3=0,000001) (ОШ1,3=10, 333, 95%ДИ=2,996-35,635). Одним из наиболее частых показаний в экстренному КС была диспропорция между размерами таза матери и головкой плода, которая отмечена во II и III группах исследования, чем в I группе (р1,2=0,0004; р1,3=0,0003) (ОШ1,2=10,074; 95%ДИ=2,595-39,112), (ОШ1,3=8,982; 95%ДИ = 2,311-34,911). Заключение: основными клинико-анамнестическими факторами риска формирования несостоятельного рубца были внутриматочные вмешательства, ВЗОМТ, генитальный эндометриоз, экстренный характер операции по поводу тазово-головной диспропорции. 

Objective: determine the clinical and anamnestic risk factors leading to the formation of an incompetent uterine scar in patients after one previous cesarean section. Materials and methods: 102 histories of patients with a uterine scar after one cesarean section, 102 newborn charts, results of pathomorphological studies of the placentas for 2019–2020. All patients were divided into 3 groups: Group 1 (control) — 35 women with a uterine scar who gave birth vaginally; Group 2 (main group A) — 35 patients with established scar incompetence after one CS before delivery; Group 3 (main group B) — 32 patients with an unsuccessful attempt at vaginal delivery and intraoperatively established uterine scar incompetence after one CS. Results: It was established that an untenable scar on the uterus is associated with intrauterine interventions on the pelvic organs (p1.2=0.031, OR1.2=2.864; 95%CI=1.086–7.552), which were statistically significantly more common in group 2 compared with group 1. Inflammatory diseases of the pelvic organs in the anamnesis were statistically significantly more common in group 2 compared with group 1 (p1.2=0.012, OR1.2=3.778; 95%CI=1.308–10.913). In group 3 with an unsuccessful attempt at vaginal delivery, genital endometriosis was statistically significantly more common compared with study groups 1 and 2 (p1.3=0.000001; p2.3=0.00003) (OR1.3=10.333. 95%CI=2.996–35.635; OR2.3=22,000; 95%DEE=4,547–106–437). In group 3, inflammatory changes in the placenta were more often noted. The emergency nature of CS and the intergenetic interval of less than 2 years and 9 months were mainly in patients with uterine scar failure. One of the most frequent indications in emergency COP was a disproportion between the size of the mother's pelvis and the fetal head, which was noted in group 1 statistically significantly more often than in groups 2 and 3 of the study (p1.2=0.0004; p1.3=0.0003) (OR1.2=10.074; 95%CI=2.595-39,112), (OR1.3=8,982; 95%CI = 2,311-34,911). Complications in the postoperative period were statistically significantly more common in groups with uterine scar failure. Conclusion: the main clinical and anamnestic risk factors leading to the formation of an incompetent scar were: intrauterine interventions, genital endometriosis, emergency nature of the operation, pelvic-cephalic disproportion, short intergenetic interval.

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The authors declare that there are no conflicts of interest present.