Correlation Analysis Of Intracavitary Two-dimensional And Three-dimensional Ultrasonography On Previous Cesarean Scar

Objective To explore the risk factors of the previous cesarean scar defect and the correlation between CSD parameters and abnormal uterine bleeding by studying the intracavitary ultrasonographic characteristics of previous cesarean scar defect by 2-D and 3-D ultrasound.Methods The clinical and imaging data of 1610 patients with cesarean section were analyzed retrospectively which diagnosed by the The Affiliated Hospital of Shandong University of TCM from January 2018 to September 2020.All patients underwent transvaginal two-dimensional and three-dimensional ultrasound examination,and the observation results were recorded in detail.According to the scar healing situation,the patients were divided into the complete scar group(1091 cases)and the scar diverticulum group(519 cases).The uterine location,scar location and frequency of cesarean section were compared between the two groups.270 cases were excluded according to the exclusion criteria,the scar integrity group was divided into the bleeding group(162 patients)and the normal menstruation group(728 patients).The scar diverticulum group was divided into the hemorrhagic group(219 patients)and the normal menstruation group(231 patients).The correlation between the length,depth,width,residual myometrial thickness and volume of scar diverticulum and abnormal uterine bleeding were analyzed.To compare the diagnostic value of depth,residual myometrial thickness and diverticulum ratio in predicting abnormal uterine bleeding.Results 1.The incidence of abnormal uterine bleeding in the intact scar group was 18.2%(162/890).and in scar diverticulum group was 48.7%(219/450),the difference was statistically significant(P<0.05).2.The incidence of scar diverticulum in the anterior and posterior uterines were 28.2%(268/950)and 38.0%(251/660),the difference was statistically significant(P<0.05).In the scar diverticulum group,the incidence of abnormal uterine bleeding in anterior position was 48.9%(1 15/235)and in posterior position was 48.4%(104/215),which suggested that posterior uteri was more likely to cause scar diverticulum,but was not significantly associated with abnormal uterine bleeding.3.1610 patients were counted,the incidence of CSD was 29.4%(387/1316)in the group with one cesarean section.The incidence of CSD was 44.9%(132/294)in the group with two or more cesarean sections,the difference was statistically significant(P<0.05).450 patients with scar diverticulum group were analyzed,the incidence of abnormal uterine bleeding was 44.9%(92/205)with one cesarean section.The incidence of abnormal uterine bleeding was 51.8(127/245)in the group with two or more cesarean sections,the difference was not statistically significant(P>0.05).4.The median distance between scar diverticulum group and scar intact group were statistically significant[0mm(range 0～6mm)vs4.0mm(range 0～13mm),P<0.05].There was no statistically significant difference in the median distance from scar to cervical opening between the bleeding group and the normal menstrual group of scar diverticulum group[0mm(range 0～6mm)vs0mm(range 0～6mm),P>0.05].5.Through the analysis of the measured parameters of CSD,univariate and multivariate Logistic regression were used for comprehensive analysis,the depth of the CSD,remained muscle layer thickness and volume were associated with abnormal uterine bleeding(all P<0.05),there was no statistical significance between the length and width of CSD in scar diverticulum bleeding group and normal menstrual group(P>0.05),the difference of depth,diverticulum ratio,residual myometrial thickness and volume between the two groups was statistically significant(P<0.05).6.According to the ROC curve,the depth of CSD,the residual myometrial thickness and the area under the curve(AUC)of diverticulum ratio were 0.721,0.779,and 0.799,the AUC values of depth,residual myometrial thickness and diverticulum ratio were compared respectively,the differences were statistically significant(Z=2.17,Z=5.15,all P<0.05).There was no significant difference between the AUC value of residual myometrial thickness and the ratio of diverticulum(Z=1.52,P>0.05).The best bounds were 3.5mm and 0.62 respectively.The sensitivity was 58.0%and 58.9%,and the specificity was 90.5%and 88.3%Conclusions 1.Multiple cesarean sections,posterior uterine and low incisions in cesarean sections were risk factors for CSD,but were not associated with abnormal uterine bleeding due to CSD2.Depth,ratio of diverticulum and volume of CSD patients with abnormal uterine bleeding were significantly higher than those in normal menstrual group,and the thickness of residual accretion was smaller than that in normal menstrual group.3.Among the indicators of CSD,the depth,residual myometrial thickness and diverticulum ratio had certain diagnostic value of abnormal uterine bleeding,Among them,diverticulum ratio had the greatest diagnostic value of abnormal uterine bleeding.4.Residual myometrial thickness and diverticulum ratio can be used as risk thresholds for predicting the occurrence of abnormal uterine bleeding.