ASSESSMENT OF APOPTOSIS FACTORS IN UTERINE SCAR REGION IN WOMEN AFTER CAESAREAN SECTION
Keywords:
uterine scar insufficiency, cesarean section, apoptosis, p53, Bcl-2, immunohistochemistry, metroplasty, tissue repair.Abstract
Objective: To evaluate the expression of apoptotic factors p53 and Bcl-2 in the uterine scar tissue and their role in the development of uterine scar insufficiency after cesarean section. Materials and Methods: A comparative study included 64 women after cesarean section, including 42 women with an insufficient uterine scar and 22 women with a competent scar. Among women with scar insufficiency, 17 underwent metroplasty during the postpartum period and 25 underwent scar excision in the remote period after cesarean section. Immunohistochemical assessment of p53 and Bcl-2 expression was performed in paraffin-embedded tissue sections using monoclonal antibodies from DAKO and the peroxidase-antiperoxidase method. The expression was evaluated according to the percentage of stained nuclei and staining intensity. Results: The highest p53 expression was observed in women with uterine scar insufficiency during the postpartum period, reaching 96.7%, which was 4.1-fold higher than in women with a competent scar. In the remote period, p53 expression was 45.2%, exceeding the level in the competent scar group by 1.9-fold. Bcl-2 expression was lowest in women with scar insufficiency during the postpartum period (10.5%), while in the remote period it increased to 72.1%, exceeding the corresponding value in women with a competent scar by 3.6-fold. A strong inverse correlation between p53 and Bcl-2 was identified in women with postpartum scar insufficiency (r=-0.93; p<0.001). Conclusion: Uterine scar insufficiency after cesarean section is associated with significant alterations in apoptotic regulation. Increased p53 expression combined with reduced Bcl-2 expression characterizes scar insufficiency in the early postpartum period, whereas persistent high Bcl-2 expression in the remote period may indicate impaired reparative remodeling and predominance of fibrous tissue in the scar.
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