Preliminary Study of Uterine Healing After Caesarean Section: CLInico-ECHOgraphic and Anatomopathologic COrrelation (COCLIECHO)

Assistance Publique - Hôpitaux de Paris

Status: Not yet enrolling

Conditions: Assessment of Uterine Healing

Treatments: Procedure: uterine biopsies

Study type: Interventional

Funder types: Other

Identifiers

NCT05785559

APHP220952

Details and patient eligibility

About

Caesarean section is one of the most common surgical procedures. The multiplication of uterine scars leads to an increase in complications and in particular those related to poor healing such as isthmocele or uterine rupture.

The processes of uterine healing at the histological scale are little known. The main objective of the research is to analyze the process of uterine healing by means of uterine biopsies performed on the areas of cesarean section scars.

Full description

Our hypothesis is that there is a histological healing defect visible on an anatomopathologic examination of the scar. This poor uterine healing on histological scale is probably associated with uterine healing defects visible on pelvic ultrasound (scar dehiscence) and clinical criteria (number of caesareans, symptoms).

The objective of the research is to analyze uterine scarring by means of uterine biopsies performed on the areas of cesarean section scars. The uterine scarred areas will be analyzed histologically according to specific criteria and compared to healthy uterine areas. Histological characteristics will be compared with clinical and ultrasound data.

Enrollment: 90 estimated patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Common to all groups:
• Adult patient,
• Signed consent for participation in the study
• Patient affiliated to a social security scheme (excluding AME)

Group 1:

• Support for a scheduled or emergency caesarean (excluding patients having an emergency caesarean (red code: caesarean within 15 minutes))
• Scarred uterus: having already benefited from a caesarean section

Group 2:

• Surgical management of caesarean section scar dehiscence after a caesarean section

Group 3 (control):

• Support for a scheduled or emergency caesarean (excluding patients having an emergency caesarean (red code: caesarean within 15 minutes)
• Healthy uterus: no history of caesarean section (history of vaginal delivery or first pregnancy)

Exclusion criteria

• Disorder of hemostasis at risk of bleeding
• Anatomopathological sampling not feasible
• Patient with a history of upper genital infections
• Patient under legal protection (guardianship, curatorship)
• Patient who does not speak or understand French
• Patient unable to answer questions or with difficulty in expressing herself

Trial design

Primary purpose: Other

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 3 patient groups

Scarred uterus

Experimental group

Description:

Patients who have already undergone one or more cesarean section(s) during a previous pregnancy and for whom a cesarean section is indicated on a scheduled or emergency basis.

Treatment:

Procedure: uterine biopsies

Scar dehiscence surgery

Experimental group

Description:

Patients who have already undergone one or more caesarean section(s) and for whom the surgical management of a dehiscence of a caesarean section scar is indicated outside of pregnancy.

Treatment:

Procedure: uterine biopsies

Healthy uterus

Experimental group

Description:

Patients with no history of caesarean section, pregnant with an indication for caesarean section: patients who have never had a caesarean section during a previous pregnancy or who are pregnant with their first pregnancy and for whom a caesarean section is indicated scheduled or urgently"

Treatment:

Procedure: uterine biopsies