Detection of Fat Cells in Uterine Scars During Normal Pregnancy and with Placenta Accreta Spectrum

Abstract

The aim was to investigate the presence of fat cells (adipocytes) using morphological methods in the uterus of women without signs of scarring, with well–off scars after cesarean section (CS), as well as in a group  of  patients  with  different  variants  of  atypical  placentation.Material  and  methods.  A  retrospective histological and immunohistochemical study of the uterine wall material obtained during abdominal delivery in normal pregnancy without a previous CS in medical history (group 1, n=10), in normal pregnancy with a previous CS in anamnesis and the presence of a scar in the uterine wall (group 2, n=23) was performed, in pregnancy complicated  by  the  ingrowth  of placental  villi  (group  3,  n=22).Results.  In  the  uteroplacental region,  the  fat component was found in all three groups. No adipocytes were found in group 1 (0%). In group 2, fields of fat cells of different sizes were found in 19 cases out of 23 studied (83%) and only in the scar zone: in serosa 40%, in the perivascular  zone 28%, among muscle bundles 15%. In the 3rd  group with the ingrowth of placental villi into the  scar zone, a “hernia” of the thinned uterine wall was detected in 68% of cases. The adipocytic component in this group was detected in 86% of cases (19 out of 22). Localization of adipocytes was observed in serosa (56%), in the perivascular zone (25%) and among muscle bundles (6%). No adipocytic component was found in the uterine wall outside the scar tissue.Conclusion. An adipocytic component was identified, undoubtedly associated with traumatic damage to the uterus and the presence of a scar in the wall. What are the relationships between the presence of fat cells in the scar tissue and its predisposition to the pathology of ingrowth of villi is unknown and requires further research.