Influence of uterotomy closure technique on uterine wall stability in subsequent pregnancies

子宫切除闭合技术对后续妊娠子宫壁稳定性的影响

• 批准号: 443517978
• 负责人: Privatdozent Dr. Thorsten Braun
• 金额: --
• 依托单位: Julius Wolff Institut für Biomechanik und Muskuloskeletale Regeneration (CVK)
• 依托单位国家: 德国
• 项目类别: Research Grants
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/443517978?language=en
• 关键词: Influence; uterotomy; closure; technique; uterine

The rate of cesarean sections has increased to over 30% in some countries in recent decades. Especially due to the risk of a rupture of the uterine scar with possibly perilous consequences for mother and child, obstetricians increasingly recommend delivery by cesarean section in subsequent pregnancies and pregnant women are reluctant to decide in favor of a trial of labor after cesarean section. However, the increase in cesarean section rate alone cannot explain the disproportionate increase in the occurrence of uterine ruptures. It seems probable, that the worldwide adoption of the Misgav-Ladach method of cesarean section around the year 2000 has played an important role. According to this method, after extraction of the fetus, the uterotomy closure is implemented in the form of a single layer continuous suture. Until the advent of this method there was no standardized suture technique. In many hospitals worldwide, the uterus was closed with interrupted sutures. We postulate that the former use of single interrupted sutures led to less strangulation of the tissue and thus caused less tissue hypoxia. Therefore, less connective tissue was formed. As single layer interrupted sutures have rarely been used in the last two decades, there are no basic science studies that have examined the impact of this uterine closure technique on uterine tissue healing and stability. The purpose of the proposed study is to investigate and provide a comprehensive comparison of the effects on myometrial healing of the four main uterine closure techniques during cesarean sections in a sheep model. 48 sheep were delivered by cesarean section. Twelve animals (4 groups) received uterine closure with the same technique. During the planned second cesarean section, a hysterectomy will be performed and the scar tissue will be characterized with regard to its features in histology, immunohistochemistry, molecular biology and biomechanical properties. We suspect the uterine tissue after interrupted sutures to be more tear-resistant because this technique has a less constrictive effect on the myometrium than continuous sutures. Therefore, it produces less necrosis and leads to a diminished scar formation (especially compared to imbricated sutures). The comprehensive design of our translational research project clearly stands out from the existing studies in this field. It promises to provide an important contribution to the understanding of the pathways of uterine healing and it shall help to develop safer methods of uterine closure during cesarean section. We believe that a lower cesarean section rate per se can be best achieved by lowering the rate of repeat cesarean sections. The anticipated insights on potential modifications of uterotomy closures will help to lower the risk of uterine ruptures and will therefore help to restore the confidence in vaginal birth after cesarean section.

近几十年来，一些国家的剖宫产率已增加到30%以上。特别是由于子宫瘢痕破裂的风险，可能对母亲和孩子造成危险后果，产科医生越来越多地建议在随后的怀孕中采用剖宫产，而孕妇不愿意决定剖宫产后进行试产。然而，剖宫产率的增加并不能单独解释子宫破裂发生率的不成比例的增加。似乎很可能，2000年左右全世界采用的米斯加夫-拉达克剖宫产法发挥了重要作用。根据该方法，在取出胎儿后，以单层连续缝合的形式进行子宫切开闭合。在这种方法出现之前，没有标准化的缝合技术。在世界各地的许多医院里，子宫都是用间断缝合线关闭的。我们假设以前使用单一中断缝合导致较少的组织绞窄，从而导致较少的组织缺氧。因此结缔组织形成较少。由于单层间断缝合在近二十年中很少使用，目前还没有基础科学研究检查这种子宫关闭技术对子宫组织愈合和稳定性的影响。本研究的目的是全面比较四种主要子宫关闭技术对绵羊剖宫产术中子宫内膜愈合的影响。48只羊经剖宫产。4组12只动物采用相同的方法闭合子宫。在计划的第二次剖宫产手术中，将进行子宫切除术，瘢痕组织将在组织学，免疫组织化学，分子生物学和生物力学特性方面进行表征。我们怀疑间断缝合后的子宫组织更抗撕裂，因为这种技术对子宫肌层的收缩作用比连续缝合小。因此，它产生较少的坏死，导致瘢痕形成减少（特别是与叠瓦缝合相比）。我们的转化研究项目的综合设计在该领域的现有研究中脱颖而出。它有望为了解子宫愈合的途径提供重要贡献，并有助于开发更安全的剖宫产术中子宫关闭方法。我们认为，降低剖宫产率本身可以通过降低重复剖宫产率来实现。对子宫切开闭合的潜在修改的预期见解将有助于降低子宫破裂的风险，从而有助于恢复剖宫产术后阴道分娩的信心。