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上升至 30% 以上。特别是由于子宫疤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通过剖腹产分娩，而孕妇不愿意决定在剖腹产后尝试分娩。然而，仅剖宫产率的增加并不能解释子宫破裂发生率的不成比例增加。 2000 年左右，世界范围内采用的 Misgav-Ladach 剖腹产法很可能发挥了重要作用。根据该方法，在取出胎儿后，以单层连续缝合的形式实施子宫切开术闭合。在这种方法出现之前，还没有标准化的缝合技术。在世界各地的许多医院中，子宫都是通过间断缝合来闭合的。我们假设以前使用单间断缝合线可以减少组织的绞窄，从而减少组织缺氧。因此，形成的结缔组织较少。由于单层间断缝合在过去二十年中很少使用，因此没有基础科学研究来检验这种子宫闭合技术对子宫组织愈合和稳定性的影响。本研究的目的是调查并全面比较绵羊模型剖宫产期间四种主要子宫闭合技术对子宫肌层愈合的影响。 48只羊通过剖腹产分娩。 12 只动物（4 组）采用相同的技术接受子宫闭合。在计划的第二次剖宫产期间，将进行子宫切除术，并对疤痕组织的组织学、免疫组织化学、分子生物学和生物力学特性进行表征。我们怀疑间断缝合后的子宫组织更耐撕裂，因为与连续缝合相比，该技术对子宫肌层的收缩作用较小。因此，它产生的坏死较少，并导致疤痕形成减少（特别是与叠瓦缝相比）。我们的转化研究项目的综合设计明显从该领域的现有研究中脱颖而出。它有望为了解子宫愈合途径做出重要贡献，并有助于开发剖宫产期间更安全的子宫闭合方法。我们认为，降低剖宫产率本身最好的方法是降低重复剖宫产率。对子宫切开术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，因此有助于恢复剖腹产后阴道分娩的信心。