Analysis Of Related Factors Of Abnormal Uterine Bleeding Caused By Cesarean Scar Diverticulum

Objective: To explore the causes of abnormal uterine bleeding caused by cesarean scar diverticulum,to study the morphological changes of cesarean scar diverticulum by transvaginal ultrasound,to compare the clinical characteristics of cesarean scar diverticulum with or without abnormal uterine bleeding,so as to further explore the morphological changes of cesarean scar diverticulum for abnormal uterine bleeding.Secondly,by studying the differential expression of estrogen receptor,progesterone receptor,vascular endothelial growth factor and von Willebrand factor in endometrial tissue of cesarean scar diverticulum and uterine cavity in the same patient,the correlation between the differential expression of these factors in different parts and abnormal uterine bleeding was preliminarily explored.Methods: From January 2019 to March 2022,patients with cesarean scar diverticulum found by transvaginal ultrasound were collected from the Affiliated Hospital of Jining Medical College.Twenty patients with normal menstruation in cesarean scar diverticulum were selected as group A,and 47 patients with abnormal menstruation in cesarean scar diverticulum were selected as group B.Patients in group A were treated with transvaginal ultrasound.The age,menstrual status and cesarean section times of the two groups were collected and analyzed in detail.The relationship between the shape,length,width,depth,residual myometrium thickness and diverticulum ratio of the scar diverticulum and abnormal menstrual bleeding in the two groups was observed by transvaginal ultrasound.The distance from the diverticulum to the external orifice of the cervix,uterine flexion angle θ,scar diverticulum angle α,scar diverticulum angle β,scar diverticulum angle γ and the projection point of point C between point A and point B were included.In this study,patients in group B were treated with laparoscopy combined with hysteroscopy.The cesarean scar diverticulum was removed and the endometrium was retained by laparoscopic vision,and the endometrium was retained by suction curettage.Immunohistochemistry was used to analyze the expression levels of estrogen receptor,progesterone receptor,vascular endothelial growth factor and von Willebrand factor in the endometrium and uterine cavity of cesarean scar diverticulum and their differential changes in different parts.Results:1.There was no significant difference in the average age between the two groups(P=0.053),but the average age of the last cesarean section in group B was larger than that in group A(P=0.029);secondly,there were38 cases(80.85%)of cesarean section in group B with more than 2 times of cesarean section.Different times of cesarean section were related to abnormal uterine bleeding caused by cesarean scar diverticulum(P<0.05).Patients in group B had more dysmenorrhea than those in group A(P<0.05).2.The parameters of diverticulum in transvaginal ultrasound were compared between the two groups.The width of diverticulum,the depth of diverticulum,the thickness of residual myometrium and the ratio of diverticulum,the distance from the diverticulum to the external orifice of the cervix were related to abnormal uterine bleeding(P<0.05).There was no correlation between abnormal uterine bleeding and uterine flexion angle θ,scar diverticulum angle α,scar diverticulum angle β,scar diverticulum angle γ and the line projection point of C point between A point and B point.3.The age of the last cesarean section,the number of cesarean sections,the width of the diverticulum and the ratio of the diverticulum were positively correlated with abnormal uterine bleeding caused by cesarean scar diverticulum(P<0.05).The thickness of the residual myometrium and the distance between the diverticulum and the external orifice of the cervix were negatively correlated with abnormal uterine bleeding caused by cesarean scar diverticulum(P<0.05),and the distance between the diverticulum and the external orifice of the cervix was an independent protective factor for abnormal uterine bleeding caused by cesarean scar diverticulum(OR=0.00,P=0.027).4.The expression intensity of estrogen receptor and progesterone receptor in the endometrium of cesarean scar diverticulum was lower than that in the endometrium of uterine cavity(P<0.05).5.The expression intensity of vascular endothelial growth factor and von Willebrand factor in the endometrium of cesarean scar diverticulum was lower than that in the endometrium of uterine cavity(P<0.05).Conclusion:1.There was a certain correlation between the age of the last cesarean section,the number of cesarean sections,dysmenorrhea and abnormal uterine bleeding caused by cesarean scar diverticulum.The width of diverticulum,the depth of diverticulum and the ratio of diverticulum in patients with abnormal uterine bleeding were larger than those in patients with normal menstruation,while the thickness of residual myometrium and the distance between diverticulum and external cervical orifice were smaller than those in patients with normal menstruation.2.The age of the last cesarean section,the number of cesarean sections,the width of the diverticulum and the ratio of the diverticulum were the risk factors for abnormal uterine bleeding in patients with cesarean scar diverticulum.The thickness of the residual myometrium and the distance from the diverticulum to the external orifice of the cervix were protective factors for abnormal uterine bleeding,and the distance from the diverticulum to the external orifice of the cervix was an independent protective factor for abnormal uterine bleeding caused by cesarean scar diverticulum.3.In the abnormal uterine bleeding group,the expression of estrogen receptor,progesterone receptor,vascular endothelial growth factor and von willebrand factor in the endometrium of cesarean scar diverticulum was lower than that in the endometrium of uterine cavity,which preliminarily verified the theory of endometrial asynchrony exfoliation and vascular dysplasia.