Analysis Of The Pathogenic Factors Of Cesarean Scar Defect

Objective To analyze the pathogenic factors of cesarean scar defect(CSD).Methods A retrospective analysis was made on the cases of patients who underwent lower uterine cesarean section in the obstetrics department of Ningxia Medical University General Hospital from May 2015 to May 2019 and who underwent transvaginal B-ultrasound three months after operation.60 cases diagnosed as CSD by transvaginal B-ultrasound were selected as the case group,and 120 cases diagnosed as good recovery of cesarean scar by transvaginal B-ultrasound were selected as the control group.Complete clinical data of the two groups of cases were collected through electronic medical records and telephone follow-up,including general conditions: age,gestational age,newborn weight;Number of caesarean sections(1,≥2);Uterine position(anterior and posterior);Timing of cesarean section: elective,incubation period,active period;Perioperative conditions: presence or absence of gestational diabetes mellitus,hypertensive disorder complicating pregnancy,uterine leiomyoma and adenomyosis,pregnancy complicated with hypothyroidism,pregnancy complicated with anemia,premature rupture of membranes,placental adhesion and placenta implantation,amniotic fluid pollution,pelvic inflammatory disease and vaginitis,uterine atony and postpartum hemorrhage,end time of lochia after operation(≤4 weeks,> 4 weeks),etc.The data were analyzed and processed by SPSS22.0 statistical software.the measurement data were expressed by mean standard deviation,independent sample t test,chi-square test for counting data and rate comparison,bonferroni chi-square division method for multiple comparisons among multiple sample rates,and multivariate data were analyzed bymultivariate Logistic regression analysis.the difference was statistically significant when p<0.05.Results1.In the general situation of the two groups,there was no significant difference in age,gestational age and neonatal weight between the two groups(P>0.05).2.In the transvaginal ultrasound examination of the two groups of patients,23 cases(38.3%)in the case group showed posteriOR uterus and 20 cases(16.7%)in the control group.compared with the two groups,the proportion of posterior uterus in the case group was higher than that in the control group,the difference was statistically significant(P<0.05),and the or value was > 1,the lower limit of 95%CI > 1,indicating that posterior uterus was a risk factor for CSD formation and anterior uterus was a protective factor for CSD.3.Scar uterus accounted for 29 cases(48.3%)in the case group and 35 cases(29.2%)in the control group.the proportion of scar uterus in the case group was higher than that in the control group,with statistically significant difference(P<0.05),and or value > 1,95% ci Lower limit > 1,that is,scar uterus is a risk factor for CSD formation,while non-scar uterus is a protective factor for CSD formation.4.In the timing of cesarean section,51 cases(85.0%)underwent elective cesarean section in the case group,7 cases(11.7%)underwent cesarean section in the latent period,2cases(3.3%)underwent cesarean section in the active period,87 cases(72.5%)underwent elective cesarean section in the control group,12 cases(10.0%)underwent cesarean section in the latent period,and 21 cases(17.5%)underwent cesarean section in the active period.compared with the control group,the timing of cesarean section in the case group was different and the difference was statistically significant(P<0.05).The difference of three different operation timing between the two groups was compared in two ways.The proportion of elective cesarean section in the case group was higher than that in the control group(X2=7.130,P=0.008).There was no significant difference between elective cesarean section and latent cesarean section(X2=0.000,P=0.992).There was no significant difference between latent cesarean section and active cesarean section(X2=3.367,P=0.067).5.The perioperative conditions of the two groups of patients include the presence or absence of gestational diabetes mellitus,hypertensive disorder complicating pregnancy,uterine leiomyoma or adenomyosis,pregnancy complicated with hypothyroidism,pregnancy complicated with anemia,premature rupture of membranes,placental adhesion and placenta implantation,amniotic fluid pollution,pelvic inflammatory disease and vaginitis,uterine atony and postpartum hemorrhage,the end time of postoperative lochia(≤4 weeks,> 4weeks),etc.there is no significant difference between the case group and the control group(P>0.05).6.Taking whether CSD is formed as dependent variable,Age,gestational week,neonatal weight,number of caesarean sections,uterine position,timing of operation,uterine leiomyoma or adenomyosis,gestational diabetes mellitus,gestational hypertension,premature rupture of membranes,placental adhesion or placenta implantation,amniotic fluid pollution,pelvic inflammatory disease or vaginitis,uterine atony or postpartum hemorrhage,lochia end time,pregnancy with hypothyroidism,pregnancy with anemia and other independent variables were analyzed by multivariate Logistic regression.Results the regression equation was finally entered for posterior uterine position,scar uterus and elective cesarean section,and the or value was > 1,the lower limit of 95%CI was > 1,i.e.posterior uterine position,scar uterus and elective cesarean section were independent risk factors for CSD formation(P<0.05).Conclusion1.Posterior uterus,cicatricial uterus and selective cesarean section are independent risk factors for the formation of cicatricial diverticulum.2.The scar diverticulum of cesarean section is more easily formed in the posterior uterus than in the anterior uterus.The scar diverticulum of cesarean section is more easily formed in the scar uterus than in the non scar uterus.The scar diverticulum of cesarean section is more easily formed in the selective cesarean section than in the active one.3.Age,gestational age,neonatal weight,uterine fibroids or adenomyosis,gestational diabetes mellitus,gestational hypertension,premature rupture of membranes,placental adhesion or placental implantation,amniotic fluid pollution,pelvic inflammation or vaginitis,uterine atony or postpartum hemorrhage,end time of lochia,pregnancy with hypothyroidism,pregnancy with anemia and so on are not clearly related to the formation of cesarean scar diverticulum.