Pregnancy in the «niche» of the scar on the uterus after cesarean section: the volumes of surgical treatment

Objective. To choose the optimal method of surgical treatment in patients with pregnancy in the «niche» of the scar on the uterus after cesarean section (CS). Material and methods. A retrospective study included 43 patients with confirmed pregnancy in an insolvent uterine scar after CS. Results. When comparing the results of the study and surgical treatment of patients with pregnancy in the uterine scar after CS, three variants of the formation of an insolvent scar are presented. Depending on the degree of the myometrial defect in the projection of the scar on the uterus after CS, possible volumes of surgical treatment in ectopic pregnancy were determined: vacuum aspiration of the fetal egg under the control of ultrasound or hysteroscopy (13.9%); metroplasty with simultaneous termination of pregnancy by vacuum aspiration of the fetal egg (76.7%); extirpation of the uterus without appendages (9.3%). Conclusion. Metroplasty with simultaneous termination of pregnancy by vacuum aspiration of the fetal egg ensures complete elimination of the fetal egg and restoration of anatomical integrity, which avoids re-attachment of the fetal egg in the scar area at the next pregnancy.