Department of Obstetrics and Gynecology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University, No. 1665 Kong Jiang Road, Shanghai, 200092, China.
Department of Gynecology, Qingdao Municipal Hospital, Shandong, 266071, China.
BMC Womens Health. 2021 May 13;21(1):199. doi: 10.1186/s12905-021-01337-x.
Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound (TVS) in nonpregnant women with cesarean section (CS) history and to build a predictive model for cesarean scar defects is very necessary.
A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment. The related clinical data were recorded and analyzed.
All patients were divided into two groups according to their clinical symptoms: Group A (N = 405) who had no cesarean scar symptoms, and Group B (N = 141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39 ± 3.34 versus 3.22 ± 2.33, P < 0.05. All patients were divided into two groups according to whether they had CSDs: Group C (N = 337) who had no CSDs, Group D (N = 209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P < 0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%, respectively.
Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.
剖宫产子宫瘢痕缺陷（CSD）严重影响女性生殖健康。本研究旨在通过经阴道超声（TVS）评估有剖宫产史的非妊娠妇女的子宫瘢痕愈合情况，并建立预测剖宫产子宫瘢痕缺陷的模型是非常必要的。
共对 607 名有经阴道超声测量下段子宫厚度的既往剖宫产史的非妊娠妇女进行了研究。记录并分析了相关的临床资料。
所有患者均根据临床症状分为两组：A 组（N=405）无剖宫产瘢痕症状，B 组（N=141）有剖宫产瘢痕症状。两组间剖宫产次数、子宫位置、CSD 检出率及 CSD 残留肌层（TRM）差异有统计学意义；两组 TRM 测量值分别为（mm）5.39±3.34 与 3.22±2.33，P<0.05。所有患者均根据是否存在 CSD 分为两组：C 组（N=337）无 CSD，D 组（N=209）超声检查有 CSD。两组间剖宫产次数、子宫位置、TRM 差异均有统计学意义（P<0.05）。在以 TVS 测量的 TRM 预测 CSD 的模型中，ROC 曲线下面积为 0.771，截断值为 4.15mm。其灵敏度和特异度分别为 87.8%和 71.3%。
无临床症状的患者经阴道超声 TRM 平均值为 5.39±3.34mm，可作为预测 CSD 修复术后患者恢复情况的良好参考。
