Clinical and Histologic Evaluation of the Hysterotomy Site and Fetal Membranes after Open Fetal Surgery for Fetal Spina Bifida Repair

Autor: Simone Brandt, Luca Mazzone, Franziska Krähenmann, Ueli Möhrlen, Margaret Hüsler, Martin Meuli, Peter K. Bode, Nicole Ochsenbein-Kölble, Roland Zimmermann
Přispěvatelé: University of Zurich, Ochsenbein-Kölble, Nicole
Rok vydání: 2018
Předmět:
Adult
Embryology
medicine.medical_specialty
medicine.medical_treatment
Extraembryonic Membranes
610 Medicine & health
Dehiscence
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Pregnancy
Fetal membrane
10049 Institute of Pathology and Molecular Pathology
medicine
2741 Radiology
Nuclear Medicine and Imaging
Humans
Radiology
Nuclear Medicine and imaging
2735 Pediatrics
Perinatology and Child Health
030212 general & internal medicine
Hysterotomy
10026 Clinic for Obstetrics
Spinal Dysraphism
Wound Healing
Fetus
030219 obstetrics & reproductive medicine
Fetal surgery
business.industry
Fetoscopy
Myometrium
Obstetrics and Gynecology
2729 Obstetrics and Gynecology
2710 Embryology
General Medicine
medicine.disease
Surgery
Uterine rupture
Pediatrics
Perinatology and Child Health
Female
business
Premature rupture of membranes
Zdroj: Fetal Diagnosis and Therapy. 45:248-255
ISSN: 1421-9964
1015-3837
Popis: Introduction: Among the risks associated with open fetal surgery, myometrium and fetal membrane issues are vexing problems since they may lead to uterine dehiscence or preterm premature rupture of membranes resulting in uterine rupture or preterm birth or both. The aim of this study was to examine whether stapled and sutured hysterotomy scars demonstrate partial or complete healing. Methods: Hysterotomy sites after open fetal surgery were clinically evaluated in 36 women during Caesarean section, classified into the categories intact, thin, and partially or completely dehiscent, then completely excised and histologically analyzed in 25 cases. The histological examination focused on wound healing of myometrium and fetal membranes. Results: The myometrium was intact, thin, and partially or completely dehiscent in 33, 58, and 9%, respectively. The interval between myelomeningocele repair and delivery did not correlate with the healing process. The myometrium showed a reparative zone (scar) with adjacent avital myometrium tissue, fibrosis, and inflammation with foreign body reaction. The intact myometrium was below 1 mm thickness in 56%. All fetal membranes showed complete dehiscence; in 41% they were completely avital. Conclusion: Our study provides evidence that the myometrium shows scarring with substantial thinning or dehiscence. Fetal membranes do not heal spontaneously. In order to prevent uterine rupture in subsequent pregnancies, we recommend the hysterotomy site to be completely excised after birth.
Databáze: OpenAIRE
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