Clinical and Morphological Assessment of Myometrium to the Patients with Abnormalities of Labor

Aim. To determine clinical and anamnestic predictors and morphological markers of the abnormalities of labor to women delivered by cesarean section (CS).

Design. A prospective cohort study in parallel groups.

Materials and methods. The study was performed at the Department of Obstetrics and Gynecology of the Kursk State Medical University in the obstetric hospital of the Kursk City Clinical Hospital of Emergency Medical Care. 110 women were examined, in whom delivery was performed at 37–41 weeks of pregnancy by С-section. The patients were divided into two groups: the main group consisted of 65 women, whose indication for CS was abnormalities of labor activity that could not be medically corrected. The comparison group included 45 pregnant women, by CS due to the development of placenta-associated complications (acute intrauterine fetal hypoxia, premature of placenta abruption, severe of preeclampsia). The criteria for exclusion from the study were multiple pregnancies, severe extragenital pathology, and age over 40 years.

The examination of the patients included the study of general and obstetric anamnesis, objective, obstetric, ultrasound, dopplerometry, morphological studies and statistical processing of the results obtained.

Results. Statistically significant differences with a predominance to patients of the main group were revealed by the following signs: "immature" cervix at full-term pregnancy; infectious-inflammatory diseases of the pelvic organs; the placenta location of the anterior wall of the uterus; history of intrauterine curettage in the anamnesis; diseases of the cardiovascular system.

Morphological examination of patients with abnormalities of labor revealed a high degree of disorganization of the smooth myocytes (p = 0.04), significant interstitial edema (p = 0.01) and a hight degree of isolating smooth myocytes (p = 0.01).

Conclusion. The analysis of clinical and anamnestic predictors and morphological data obtained after the first CS will allow of women at risk for predicting anomalies of labor at the time subsequent pregnancy and optimizing their delivery tactics.

1. Ailamazyan E.K. Obstetrics: textbook. М.: GEOTAR-Media; 2019: 450–67. (in Russian)

2. Thuillier C., Roy S., Peyronnet V., Quibel T. et al. Impact of recommended changes in labor management for prevention of the primary cesarean delivery. Am. J. Obstet. Gynecol. 2018;218(3):341.e1–9. DOI: 10.1016/j.ajog.2017.12.228

3. Pekarev O.G., Brega E.S., Lunkov S.S., Gus A.I. Clinical and elastographic assessment of immature vesical cervix preparations for delivery. Doctor.Ru. 2019;11(166):22–8. (in Russian). DOI 10.31550/1727-2378-2019-166-11-22-28

4. Milyaeva N.M., Kovalev V.V., Tretyakova T.B., Pestryaeva L.A. et al. Possibilities of personified prediction the formation of the primary powerless labour and severity. Ural Medical Journal. 2018;13(168): 33–9. (in Russian). DOI 10.25694/URMJ.2018.13.44

5. Savelyeva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., eds. Obstetrics: national leadership. M.: GEOTAR-Media; 2019: 1080 p. (in Russian)

6. LeFevre N.M., Krumm E., Cobb W.J. Labor dystocia in nulliparous women. Am. Fam. Physician. 2021;103(2):90–6

7. Mudrov V.A., Yakimova A.V., Ziganshin A.M. Optimisation of the delivery method for women in development of abnormalities of labour. Siberian Medical Review. 2022;3(135):49–56. (in Russian). DOI: 10.20333/25000136-2022-3-49-56

8. Strizhakov A.N., Ignatko I.V., Davydov A.I. Obstetrics: textbook. M.: GEOTAR-Media; 2020. 1072 p. (in Russian)

9. Hamm R.F., Teefey C.P., Dolin C.D., Durnwald C.P. et al. Risk of cesarean delivery for women with obesity using a standardized labor induction protocol. Am. J. Perinatol. 2021;38(14):1453–8. DOI: 10.1055/s-0041-1732459

10. Nahaee J., Abbas-Alizadeh F., Mirghafourvand M., Mohammad-Alizadeh-Charandabi S. Pre- and during- labour predictors of dystocia in active phase of labour: a case-control study. BMC Pregnancy Childbirth. 2020;20(1):425. DOI: 10.1186/s12884-020-03113-5

11. Qian Х., Shi S.Q., Li P., Garfield R.E. et al. Simultaneous recording and analysis of uterine and abdominal muscle electromyographic activity in nulliparous women during labor. Reprod. Sci. 2017;24(3):471–7. DOI: 10.1177/1933719116658704

12. Sivarajasingam S.P., Imami N., Johnson M.R. Myometrial cytokines and their role in the onset of labour. J. Endocrinol. 2016;231(3):R101–19. DOI: 10.1530/JOE-16-0157

13. Monir-Bishty E., Pierce S.J., Kupittayanant S., Shmygol A. et al. The effects of metabolic inhibition on intracellular calcium and contractility of human myometrium. BJOG. 2003;110(12):1050–6

14. Saucedo A.M., Cahill A.G. Evidence-based approaches to labor induction. Obstet. Gynecol. Surv. 2023;78(3):171–83. DOI: 10.1097/OGX.0000000000001110

15. Tskhay V.B., Domracheva M.Ya., Mentsik M.M., Bryuhanova A.A. et al. Comparative analysis of the efficacy and safety of different methods of labor induction in full-term pregnancy: a randomized prospective study. Problems of Gynecology, Obstetrics and Perinatology. 2024;23(2): 38–44. (in Russian). DOI: 10.20953/1726-1678-2024-2-38-44

16. Vyas V., Guerra D.D., Bok R., Powell T. et al. Adiponectin links maternal metabolism to uterine contractility. FASEB J. 2019;33(12):14588–601. DOI: 10.1096/fj.201901646R

17. Podtetenev A.D., Bratchikova T.V., Kotaish G.A. Regulation of labor activity: teaching aid. M.: RUDN; 2004. 24 p. (in Russian)

18. Petrich L.N., Novikova O.N. Risk factors of abnormal uterine activity. Fundamental and Clinical Medicine. 2021;6(2):59–65. (in Russian). DOI: 10.23946/2500-0764-2021-6-2-59-65

19. Zefirova T.P., Maltseva L.I. Prediction of abnormal labor activity in pregnant females with chronic urogenital infection. Russian Bulletin of Obstetrician-Gynaecologist. 2007;7(2):21–6. (in Russian)

20. Bologov M.A., Penzhoyan G.A. Study of multiple factors influencing the development of anomalies of labor activity. Kuban Scientific Medical Bulletin. 2018;25(2):45–51. (in Russian). DOI: 10.25207/1608-6228-2018-25-2-45-51

21. Liu Y., Gong Q., Yuan Y., Shi Q. Prediction model for labour dystocia occurring in the active phase. J. Obstet. Gynaecol. 2023;43(1):2174837. DOI: 10.1080/01443615.2023.2174837

22. Lilly R. Pathohistological technique and practical histochemistry. M.: World; 1969. 646 p. (in Russian)

23. Denisova T.G., Habibrahmanova L.H., Shornikov A.I., Irgasheva R.U. et al. Anomalies of labor activity. The problem of modern obstetrics. Current ways of prevention. Healthcare of Chuvashia. 2021;4:67–79. (in Russian). DOI: 10.25589/GIDUV.2021.26.83.008

24. Guan P., Tang F., Sun G., Ren W. Prediction of emergency cesarean section by measurable maternal and fetal characteristics. J. Investig. Med. 2020;68(3):799–806. DOI: 10.1136/jim-2019-001175

25. Grishchenko O.V. Mamedova S.Sh. Prediction of weakness of labor activity that led to cesarean section. Reproductive Medicine. 2020;2 (43): 56–60. (in Russian). DOI 10.37800/RM2020-1-14

26. Melnik E.V. Features of anamnesis in women with weakness of labor activity. Modern Perinatal Medical Technologies in Solving Demographic Security Problems. 2021;14:205–14. (in Russian)

27. Chen L., Wang L., Luo Y., Huang Q. et al. Integrated proteotranscriptomics of human myometrium in labor landscape reveals the increased molecular associated with inflammation under hypoxia stress. Front. Immunol. 2021;12:722816. DOI: 10.3389/fimmu.2021.722816

28. Shokirova U.G., Pakhomov S.P., Lebedeva O.P., Ustyuzhina А.S. et al. Character of the course of the second half of pregnancy in women with labor dystocia. Health Care of Tajikistan. 2021;1:73–8. (in Russian)

29. Mudrov V.A. Possibilities for predicting abnormal labor at the present stage. Journal of Obstetrics and Women's Diseases. 2020;69(5):13–26. (in Russian). DOI: 10.17816/JOWD69513-26