Analysis Of Influencing Factors Of Previous Cesarean Scar Defect And Observation Of The Effect Of Transcutaneous Electrical Nerve Stimulation In Preventing The Formation Of It

Objective:Previous cesarean scar defect(PCSD),also known as cesarean scar diverticulum(CSD),is one of the common long-term complications after cesarean scar defect.This disease is caused by poor healing of the uterine incision after the lower section of the uterus cesarean section,leading to the incision forming a depression communicated with the uterine cavity.As the valve at the scar defect obstructs the drainage of menstrual blood,menstrual blood accumulates in the patient,thus forming a diverticulum.PCSD often presents with prolonged menstruation,irregular vaginal bleeding,dysmenorrhea and other symptoms,which may lead to secondary infertility,pregnancy in scar defect and other risks.At present,the cause of PCSD is not clear,and the effect of surgical treatment is limited.There is still a possibility of recurrence after surgery,which has a great impact on the life and economy of patients.In this study,the influence factors of PCSD were analyzed,and the effect of transcutaneous electrical nerve stimulation(TENS)on preventing the formation of PCSD was observed,providing ideas and methods for further reducing the occurrence of the disease in the future.Methods:1.Ninety-five patients with transvaginal ultrasonography as PCSD in the Fourth Affiliated Hospital of Jiangsu University were selected as the PCSD group and 95 patients with normal transvaginal ultrasonography during the same period were selected as non-PCSD group.The general situation,the situation before cesarean section,cesarean section operation situation,the situation after cesarean section,pregnancy complications and complications of the two groups of patients during hospital delivery were observed and compared.And then according to the comparative results of the Logistic regression model to analyze the influence factors of PCSD.2.A total of 151 primipara who delivered by cesarean section for the first time in the Fourth Affiliated Hospital of Jiangsu University were selected and divided into study group A,study group B and the control group.Study group A and study group B were treated with TENS after cesarean section,while the control group was treated with routine postpartum care without intervention.The general data,operating-related indicators,postoperative menstruation,and the results of transvaginal ultrasound examination at 42 days and 6 months postpartum were compared among the three groups of women,and then the prevention effect of TENS on the formation of PCSD was observed.Results:1.There were differences in parity,gravidity,history of multiple cesarean sections,last cesarean section’s gestation days,preoperative hemoglobin,preoperative platelet,preoperative fibrinogen,vaginal trial labor transferred to cesarean section,emergency surgery,postoperative hemoglobin,postoperative pyrexia,anemia and hypertensive disorder complicating pregnancy between the PCSD group and the non-PCSD group.The difference was statistically significant(P<0.05).Binary multivariate Logistic regression analysis showed that parity,history of multiple cesarean sections,preoperative fibrinogen,postoperative pyrexia and anemia were the influencing factors of PCSD.Among them,preoperative fibrinogen was a protective factor affecting the formation of PCSD(P<0.05,OR=0.665).While parity,history of multiple cesarean sections,postoperative pyrexia and anemia were risk factors(P<0.05,OR>1).2.There was no significant difference in general information and operation related indicators among the study group A,study group B and control group(P>0.05).And there was no significant difference in uterine size between the three groups at 42 days and 6 months after delivery(P>0.05).There were 5 cases(10%)of PCSD in study group A,2 cases(4%)in study group B,and13 cases(26%)in control group at 42 days after delivery.There was a significant difference in the incidence of PCSD at 42 days postpartum among the three groups(P<0.05).The results of transvaginal ultrasound detection 6 months after delivery showed that the PCSD formation rate of study group A(12%)and study group B(4%)was lower than that of the control group(28%),and the difference was statistically significant(P<0.05).However,there was no significant difference in the formation rate of PCSD 42 days and 6 months after delivery between study group A and study group B(P>0.05).Conclusions:1.Parity,preoperative fibrinogen,history of multiple cesarean sections,postoperative pyrexia and anemia are related factors affecting the occurrence of PCSD.Among them,preoperative fibrinogen is a protective factor for the formation of PCSD,while parity,history of multiple cesarean sections,postoperative pyrexia and anemia are risk factors for the formation of PCSD.2.The application of TENS on the uterine incision 6 hours after cesarean section has a certain effect on preventing the formation of PCSD,which may become a new physical therapy method to prevent the formation of PCSD,and this method is non-invasive,painless,and has no side effects.In addition,PCSD can be detected by transvaginal ultrasound at 42 days postpartum,and the size of the diverticulum detected in the early stage is little changed from that detected at 6months postpartum.