Caesarean section scar: Histological analysis on hysterectomy specimen. A pilot study

Area of Science:

• Reproductive Biology
• Gynecological Pathology
• Surgical Outcomes

Background:

• Rising global caesarean section (CS) rates correlate with increased CS scar complications.
• Uterine healing post-CS is complex and not fully understood.
• Complications include scar dehiscence and uterine rupture.

Purpose of the Study:

• To conduct a comparative histological analysis of healthy uterine tissue versus tissue with previous caesarean section scars.
• To investigate the structural changes in the myometrium and overall uterine wall thickness after CS.

Main Methods:

• Prospective inclusion of women undergoing hysterectomy for benign pathology.
• Division into two groups: previous CS (group 1) and control (group 2).
• Histological and immunohistochemical analysis of hysterectomy specimens.

Main Results:

• Scarred uterine tissue (group 1) showed significantly reduced total wall thickness compared to adjacent healthy isthmus and control group (p < 0.001).
• Myometrial thickness within the scar was significantly thinner than adjacent healthy isthmus and control group (p < 0.001).
• Fibrosis was significantly increased in the CS scar tissue (55.01%) compared to adjacent (17.41%) and healthy uterine tissue (33.91%).

Conclusions:

• Uterine scars following caesarean section result in reduced wall and myometrial thickness.
• A significant increase in fibrosis is characteristic of CS scars.
• These structural deficits in scarred uteri persist long-term, warranting further investigation into pathophysiology.