The Study Of The Relationship Between The Clinical Data And Expression Of Type I And â…¢ Collagen In Different Phase After Cesarean Section

Objective: To analyze and summarize the clinical data and situation duringcesarean section of354pregnant women who were choosing to cesarean section again,and to study the expression of type I and III collagen of uterine scar muscle in differentinterval times, to discuss the relationship between the interval of secondary pregnancyand healing of uterine scar and the factors that may influence the healing of uterine scarmuscle.Methods: From January2012to December2013,354pregnant women aftercesarean section chose to repeat cesarean section in People’s Liberation Army (PLA)NO.202Hospital, who agreed with taking uterine scar muscle tissue (observation group),10pregnant women of cesarean section were divided into control group, who were firstcesarean section for obstetrics complication and agreed with taking normal uterinemuscle tissue. To analyze and summarize the clinical data and situation duringcesarean section of354pregnant women who were choosing to cesarean section again;To detect the expression of type I and III collagen of uterine scar and nomal musclein1~20years after cesarean section by HE staining and SP immunohisto-chemical, alsoto analyze the expressed results by statistics.Results: Based on the thickness of uterine scar during cesarean section surgery,those pregnant women were divided into3groups: in279cases uterine muscle asintegrity, in43cases uterine muscle as thin and in32cases uterine muscle as rupture.1. To analyze relevant factors with heahing of uterine scar muscle. (1) No significant statistical difference among three groups analyzed, includingpregnant women age, pregnant women BMI (body mass index), gestational weeks,thenumber of pregnancy, cesarean delivery times and birth weight (P>0.05).(2) relationship between pelvic adhesion and healing of uterine scar: based onpelvic adhesions during cesarean section surgery, those pregnant women were dividedinto4levels. Uterine muscle as rupture rat and uterine muscle as thin with rate in the nopelvic adhesion, I level and II level were no statistical difference (P>0.05). Uterinemuscle as rupture rat and uterine muscle as thin rate in III level, IV level pelvicadhesions were no statistical difference (P>0.05). Uterine muscle as rupture rat anduterine muscle as thin rate between the no pelvic adhesions, I level, III level, III leveland IV level pelvic adhesions were significantly statistical difference (P<0.001).(3) Relationship between interval of last pregnancy with cesarean section surgeryand healing of uterine scar: Uterine muscle rupture rate and uterine muscle thin rate ininterval less than2years group were higher than2~4years group,4~6years group,6~8years group and8~10years group, respectively (all P<0.001); There were no statisticaldifference between interval less than2years group and more than10years group(P>0.05). Uterine muscle rupture rate and uterine muscle thin rate in interval2~4yearsgroup were lower than4~6years group,6~8years group and8~10years group,respectively (all P<0.05). Uterine muscle rupture rate and uterine muscle thin rateamong interval4~6years group,6~8years group and8~10years group were nostatistical difference (P>0.05).(4) Relationship between healing of uterine scar and pregnancy outcome:Summation of harmful pregnancy outcome29cases (69%) in uterine muscle rupturegroup were higher than5cases (11.9%) in uterine muscle integrity group and8cases(19.0%) in uterine muscle thin group, which reached statistical difference (P<0.05).Summation of harmful pregnancy outcomes in uterine muscle integrity group anduterine muscle thin group were no statistical difference (P>0.05).(5) Relationship healing of uterine scar and perinatal infant outcome: Summationof harmful perinatal infant outcome19cases (48.7%) in uterine muscle rupture group were higher than6cases (15.4%) in uterine muscle integrity group and14cases (35.9%)in uterine muscle thin group, which reached statistical difference (P<0.001). Summationof harmful pregnancy outcomes in uterine muscle integrity group and uterine musclethin group were significantly statistical difference(P<0.05).2. Result of hematoxylin and eosin (HE) staining: In2years after cesarean sectionsurgery, histopathologic examination of uterine scar muscle tissues revealed evidence ofaltered healing including collagen fiber hyperplasia and disorder, granulation tissue nun,serious inflammation, microvascular proliferation; In2~4years, it included weakinflammation, smooth muscle cells repaired; In4~6years, it included fibroblasts,enlarged collagen fiber bundles; Interval6~8years, it included enlarged collagen fiberbundles, smooth muscle cells denaturation; Interval8~10years, it included enlarged anddisorder collagen fiber bundles, nodular permutation network in part, microvascularproliferati-on; After more than10years, it included enlarged collagen fiber bundles,smooth muscle cells denaturation, microvascular proliferation, absence of elastic fibers.Immunohistochemical result: Type I and III collagen expressed in hyperplasiacollagen fiber,and were stained brown.Normal and scar (1~20years) smooth musclecells all expressed type I and III collagen.Grade of type I and III collagen:There weresignificantly statistical difference between interval less than2years group and controlgroup (P<0.001), grade between interval less than2years group and interval more than10years were no statistical difference (P>0.05), however, There were statisticaldifference between interval less than2years group and other four interval groups(P<0.05); There were no statistical difference between interval2~4years group andcontrol group (P>0.05), There were significantly statistical difference between interval2~4years group and other five interval groups (P<0.001). There were no statisticaldifference among interval4~6,6~8and8~10years group (P>0.05), grade between themand control group were statistical difference (P<0.001).Conclusion:1. The following factors were related with heahing of uterine scar muscle,including pregnant women age, pregnant women BMI (body mass index), gestational weeks, the number of pregnancy, cesarean delivery times, birth weight and pelvicadhesion.2. There was a closely relation of harmful healing of uterine scar with harmfulpregnancy outcome and harmful perinatal infant outcome.3. Good healing of uterine scar was more likely to happen in interval2~4years,but bad healing of uterine scar was more likely to happen in interval less than2yearsand more than10years.4. As to the study, type I and III collagen expressed of uterine scar muscle ininterval2~4years between pregnancy and cesarean section surgery and normal uterinemuscle,which has no difference. So I infer thay the best times of uterine scar healingmay be2~4years after cesarean section.