Development of a rabbit model of uterine rupture after caesarean section, Histological, biomechanical and polarimetric analysis of the uterine tissue

Uterine rupture is a major complication of caesarean section (CS) associated with a high foetal and maternal morbidity. The objective is to develop an in-vivo model of uterus healing and rupture after CS in order to analyse histological phenomena controlling scarring tissue development and potential cause of defects. Eighteen pregnant primiparous female rabbits were bred naturally. At caesarean, after 28 days of gestation, foetuses were either extracted through a longitudinal incision in one of the uterine horns (“CS horn”) or via a short incision at the tip of the contralateral horn (“control horn”). The uterine horns were sutured by single layer, all by the same surgeon. They were mated again 14 days later and euthanized at G28. Genital tracts were collected for histological, biomechanical and polarimetric analyses. Macroscopically, 2/18 presented a dehiscence and 1/18 a spontaneous rupture. The mean thickness of the scarred area was significantly lower 0.9 mm [0.7-1.4] that the non-scarring area on CS horns 2.2 [1.6-2.3] or control horns 2 [1.5-2.3] (p<0.0001). The scar zone was statistically more fibrous (p<0.0001), containing fewer vessels (p=0.03) and oestrogen (p<0.001) and progesterone receptors (p<0.0001). After balloon inflation, ruptured occurred in the scar zone in 8 out of 17 cases (47%). Polarimetry revealed that the scar zone was statistically inhomogeneous (73%). Multifactorial analysis allowed to identify groups with poor uterine healing and less resistant to rupture (balloon inflation) mostly in case of thin myometrium in the scar and a group with strong resistant to rupture and correct healing characteristics. Lay summary Caesarean section rates are rising across the world. When a caesarean section is carried out, it can lead to scarring on the uterus that can affect its resistance to pressure. During the next pregnancy, the uterus can tear, increasing risks to the mother and baby. We carried out caesarean sections in a rabbit, allowing us to analyse the scar on the uterus, the healing and tissue resistance. The scarred part of the uterus was statistically thinner, more fibrous and contained fewer vessels and hormone receptors than the area without scarring. Under similar conditions, poor healing was observed in some animals, reducing resistance in following pregnancies. These results suggest that individual and genetic factor have an effect on healing after a caesarean section. This study may enable us to improve our knowledge and management care for patients who have a caesarean section in order to reduce complications.