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增加到30％以上。特别是由于子宫疤痕破裂的风险可能会对母亲和儿童造成危险的后果，妇产科医生越来越建议剖宫产在随后的怀孕和孕妇中分娩。但是，仅剖宫产率的增加无法解释子宫破裂发生的不成比例增加。似乎很有可能在2000年左右在全球范围内采用Misgav-Ladach方法，发挥了重要作用。根据这种方法，提取胎儿后，子宫切开术以单层连续缝合形式实施。在这种方法的出现之前，没有标准化的缝合技术。在全球许多医院中，子宫被打断的缝合线关闭。我们假设以前使用单个中断缝合线导致组织扼杀较少，从而导致组织缺氧较少。因此，形成了较少的结缔组织。由于在过去的二十年中很少使用单层中断的缝合线，因此没有基础科学研究检查了这种子宫闭合技术对子宫组织愈合和稳定性的影响。拟议研究的目的是研究并提供对绵羊模型中剖宫产期间四种主要子宫闭合技术对肌层愈合的影响的全面比较。 48羊是由剖宫产部门运送的。十二只动物（4组）接受了相同技术的子宫闭合。在计划的第二个剖宫产部分中，将进行子宫切除术，并将疤痕组织在组织学，免疫组织化学，分子生物学和生物力学特性方面的特征。我们怀疑中断缝合线后的子宫组织更具泪水，因为该技术对子宫肌层的约束作用比连续缝合线更少。因此，它会产生较少的坏死，并导致疤痕形成减少（尤其是与脑缝合线相比）。我们的转化研究项目的全面设计显然在该领域的现有研究中脱颖而出。它有望为对子宫愈合途径的理解做出重要贡献，并且在剖宫产期间有助于开发更安全的子宫闭合方法。我们认为，可以通过降低重复剖宫产的速率来最好地实现较低的剖宫产率。对子宫切开术的潜在修饰的预期见解将有助于降低子宫破裂的风险，因此将有助于恢复剖宫产后阴道出生的信心。