Abstract
References
- 1. Antila-Långsjö RM, Mäenpää JU, Huhtala HS, Tomás EI, Staff SM. Cesarean scar defect: a prospective study on risk factors. Am J Obstet Gynecol 2018;219:458.e1-e8.
- 2. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Med Bras (1992) 2019;65:714-21.
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- 6. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015;30:2695-702.
- 7. Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A. Uterine wound healing: a complex process mediated by proteins and peptides. Curr Protein Pept Sci 2017;18:125-8.
- 8. Buhimschi CS, Zhao G, Sora N, Madri JA, Buhimschi IA. Myometrial wound healing post-Cesarean delivery in the MRL/MpJ mouse model of uterine scarring. Am J Pathol 2010;177:197-207.
- 9. Roeder HA, Cramer SF, Leppert PC. A look at uterine wound healing through a histopathological study of uterine scars. Reprod Sci 2012;19:463-73.
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- 14. Setubal A, Alves J, Osório F, Guerra A, Fernandes R, Albornoz J, et al. Treatment for uterine isthmocele, A pouchlike defect at the site of a cesarean section scar. J Minim Invasive Gynecol 2018;25:38-46.
- 15. Park JE, Barbul A. Understanding the role of immune regulation in wound healing. Am J Surg 2004;187(5a):11s-6s.
- 16. Kaitu'u-Lino TJ, Morison NB, Salamonsen LA. Neutrophil depletion retards endometrial repair in a mouse model. Cell Tissue Res 2007;328:197-206.
- 17. Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Renewal by multipotent stem cells: Blood cell formation. Molecular Biology of the Cell. 4th edition. Garland Science; 2002.
- 18. Maruyama Y, Inoue K, Mori K, Gorai K, Shimamoto R, Onitsuka T, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as predictors of wound healing failure in head and neck reconstruction. Acta Otolaryngol 2017;137:106-10.
- 19. Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia? J Matern Fetal Neonatal Med 2019;32:1412-9.
- 20. Zhuo Y, Cai D, Chen J, Zhang Q, Li X. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia. Medicine (Baltimore) 2021;100:e25007.
Exploring the role of inflammatory parameters in predicting isthmocele formation following planned cesarean section: a study in patients with a history of one previous cesarean
Abstract
Objectives: Isthmocele is a hypoechoic area within the lower uterine segment myometrium, resulting from a discontinuation of the myometrium at the site of a previous cesarean scar. The aim of this study was to examine the influence of maternal cellular and inflammatory status prior to Cesarean Section (CS) on isthmocele formation.
Methods: This prospective observational study was conducted in a tertiary hospital and included women with a history of one previous CS. The inflammatory and cellular parameters were collected and ultrasonographic examinations were conducted in the 6th postpartum month and then analyzed. Logistic regression analysis was performed to identify potential factors influencing isthmocele formation.
Results: Of the 106 patients, 31 (29.2%) were diagnosed with isthmocele after one previous CS. There were no significant differences in terms of demographical variables between the groups. However, the duration of CS was significantly longer in the isthmocele group compared to the group without isthmocele (42.58 ± 8.77 vs. 38.42 ± 9.50 minutes, p = 0.03). The neutrophil-to-lymphocyte ratio (NLR) was higher and platelet-to-lymphocyte ratio (PLR) was lower in the isthmocele group (p < 0.001). Logistic regression analysis revealed that, NLR (OR [odds ratio]: 0.23, 95% CI [confidence interval]: 0.117- 0.473, p < 0.001) and PLR (OR: 1.05, 95% CI: 1.027-1.078, p < 0.001) were identified as independent predictors for isthmocele formation after planned CS.
Conclusion: Inflammatory markers, such as NLR and PLR, may contribute to the formation of isthmocele in women with a history of one previous CS, shedding light on the underlying pathophysiology.
Keywords
Cesarean scar defect isthmocele neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio
References
- 1. Antila-Långsjö RM, Mäenpää JU, Huhtala HS, Tomás EI, Staff SM. Cesarean scar defect: a prospective study on risk factors. Am J Obstet Gynecol 2018;219:458.e1-e8.
- 2. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Med Bras (1992) 2019;65:714-21.
- 3. Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean niche (isthmocele) in uterine scar: an update. J Obstet Gynaecol India 2020;70:440-6.
- 4. Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol 2016;23:893-902.
- 5. Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, et al. Isthmocele: from risk factors to management. Rev Bras Ginecol Obstet 2019;41:44-52.
- 6. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015;30:2695-702.
- 7. Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A. Uterine wound healing: a complex process mediated by proteins and peptides. Curr Protein Pept Sci 2017;18:125-8.
- 8. Buhimschi CS, Zhao G, Sora N, Madri JA, Buhimschi IA. Myometrial wound healing post-Cesarean delivery in the MRL/MpJ mouse model of uterine scarring. Am J Pathol 2010;177:197-207.
- 9. Roeder HA, Cramer SF, Leppert PC. A look at uterine wound healing through a histopathological study of uterine scars. Reprod Sci 2012;19:463-73.
- 10. Baum CL, Arpey CJ. Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Dermatol Surg 2005;31:674-86; discussion 86.
- 11. Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget 2017;8:75381-8.
- 12. Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG 2010;117:1119-26.
- 13. van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG 2014;121:236-44.
- 14. Setubal A, Alves J, Osório F, Guerra A, Fernandes R, Albornoz J, et al. Treatment for uterine isthmocele, A pouchlike defect at the site of a cesarean section scar. J Minim Invasive Gynecol 2018;25:38-46.
- 15. Park JE, Barbul A. Understanding the role of immune regulation in wound healing. Am J Surg 2004;187(5a):11s-6s.
- 16. Kaitu'u-Lino TJ, Morison NB, Salamonsen LA. Neutrophil depletion retards endometrial repair in a mouse model. Cell Tissue Res 2007;328:197-206.
- 17. Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Renewal by multipotent stem cells: Blood cell formation. Molecular Biology of the Cell. 4th edition. Garland Science; 2002.
- 18. Maruyama Y, Inoue K, Mori K, Gorai K, Shimamoto R, Onitsuka T, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as predictors of wound healing failure in head and neck reconstruction. Acta Otolaryngol 2017;137:106-10.
- 19. Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia? J Matern Fetal Neonatal Med 2019;32:1412-9.
- 20. Zhuo Y, Cai D, Chen J, Zhang Q, Li X. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia. Medicine (Baltimore) 2021;100:e25007.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | August 10, 2023 |
| Publication Date | September 4, 2023 |
| Submission Date | June 16, 2023 |
| Acceptance Date | July 18, 2023 |
| Published in Issue | Year 2023 Volume: 9 Issue: 5 - September 2023 |
