ASSESSMENT OF UTERINE SCAR USING MATHEMATICAL MODELING BASED ON CLINICAL, MOLECULAR AND GENETIC PREDICTORS
Objective. To increase effectiveness of uterine scar assessment after previous C-section using methods of complex mathematical modeling. Methods. Patients with history of uterine scar from previous C-section ages 18-40 years of age were enrolled in the study: 80 pregnant patients comprised a group with non-viable uterine scar, while another 80 patients had viable uterine scar. In terms of clinical end-point we used method of mathematical modeling when looking for evidence of non-viable uterine scar. Assessment of scar viability was conducted intraoperatively with follow up of morphological studies of scar tissue and adherent myometrium. Molecular and genetic methods for scar assessment were accomplished by using single nucleotide polymorphism (SNP) associated with inadequate homeostasis of connective tissue. Results. We propose low sensitivity of diagnostic ultrasound (37.5%) with moderate specificity (82.5%). As an alternative, a mathematical model was developed to assess scar viability based on genetic predictors allowing us to increase sensitivity of ultrasound screening to 46%. Using complex modeling that included results of diagnostic ultrasounds and genotypes MMP2: -735 C>A, VEGFA: -634 (-94) G>C, VEGFA: 936 C<T, ESR1: 2014 G>A (Thr594Thr) allowed us to increase sensitivity to 59.3% with specificity of 89.2%. Discussion. Using molecular and genetic screening methods in combination with traditional diagnostic standards allowed for a more accurate assessment of uterine scar after previous C-section in determination for the best mode of delivery.