Uterine Cesarean Scar Tissue-An Immunohistochemical Study

Abstract

Background and Objectives: Wound healing encompasses a multitude of factors and entails the establishment of interactions among components of the basement membrane. The quantification of particle concentrations can serve as valuable biomarkers for assessing biomechanical muscle properties. The objective of this study was to examine the immunoexpression and immunoconcentration of myometrial collagen type VI, elastin, alpha-smooth muscle actin, and smooth muscle myosin heavy chain, as well as the expression of platelets and clusters of differentiation 31 in the uterine scar following a cesarean section (CS). Materials and Methods: A total of 177 biopsies were procured from a cohort of pregnant women who were healthy, specifically during the surgical procedure of CS. The participants were categorized into seven distinct groups. Group 1 consisted of primiparas, with a total of 52 individuals. The subsequent groups were organized based on the duration of time that had elapsed since their previous CS. The analysis focused on the immunoexpression and immunoconcentration of the particles listed. Results: No significant variations were observed in the myometrial immunoconcentration of collagen type VI, elastin, smooth muscle myosin, and endothelial cell cluster of differentiation 31 among the analyzed groups. The concentration of alpha-smooth muscle actin in the myometrium was found to be significantly higher in patients who underwent CS within a period of less than 2 years since their previous CS, compared to those with a longer interval between procedures. Conclusions: Our findings indicate that the immunoconcentration of uterine myometrial scar collagen type VI, elastin, smooth muscle myosin heavy chain, alpha-smooth muscle actin, and endothelial cell marker cluster of differentiation 31 remains consistent regardless of the duration elapsed since the previous CS. The findings indicate that there are no significant alterations in the biomechanical properties of the uterine muscle beyond a period of 13 months following a CS.

Keywords: cesarean section; cluster of differentiation 31 antigen; immunohistochemistry; uterine cesarean scar.

Figure 1

The location and method of the myometrial sample excision, taken from the lower uterine segment during the cesarean section.

Figure 2

The myometrial immunoconcentration of alpha-smooth muscle actin was analyzed in the different groups, and the results were measured in square micrometers (μm²).

Figure 3

The myometrial immunoconcentration of smooth muscle myosin heavy chain was analyzed in the different groups, and the results were measured in square micrometers (μm²).

Figure 4

The myometrial immunoconcentration of collagen type VI was analyzed in the different groups, and the results were measured in square micrometers (μm²).

Figure 5

The myometrial immunoconcentration of the endothelial cell marker CD31 was analyzed in the different groups, and the results are measured in square micrometers (μm²).

Figure 6

The percentage of immunopositive myosin-staining cells in scar tissue in the analyzed groups.

Figure 7

An example of digital images of the myometrial distribution of elastin, collagen type VI, alpha-smooth muscle actin, smooth muscle myosin heavy chain, and endothelial cell marker CD31 (cluster of differentiation). The left panel presents the immunohistochemical expression of the studied proteins; the right panel is a digital image, in which the product of the reaction is shown in strong red. IHC (immunohistochemistry); original objective magnification: 20×.