Abstract
The association of residual myometrium thickness (RMT) and scar defect depth (D) with menstrual abnormalities and the effectiveness of vaginal repair remain to be determined in patients with cesarean section scar diverticulum (CSD). To assess the value of ultrasound to predict vaginal repair effectiveness. This was a retrospective study of patients with CSD treated with vaginal repair between 01/2014 and 02/2016 at Shanghai First Maternity and Infant Hospital (Tongji University). Transvaginal ultrasound was performed before and 3 months after surgical repair. RMT, D, scar defect length (L), and scar defect width (W) were measured. Width (W), D, and L increased along the duration of menstrual period (P < 0.05). When the menstrual extension time was ≥15 days, RMT/D and RMT/(RMT + D) were smaller than in patients with period <15 days (P < 0.05). L was the most positively correlated ultrasonic parameter with menstrual prolongation (r = 0.492). RMT/D and RMT/(RMT + D) were negatively correlated with prolonged menstruation (r = ‐0.304 and -0.305, respectively). RMT/D and RMT/(RMT + D) were associated with the disappearance of CSD after vaginal repair (P < 0.05). The cutoff value of RMT/(RMT + D) was 0.496, with sensitivity of 53.0% and specificity of 61.4%. L of CSD is closely correlated with menstrual extension but has no relationship with the effectiveness of surgery. RMT/(RMT + D) is correlated with menstrual extension time ≥15 days and the effectiveness of vaginal repair.
Highlights
In 1985, the World Health Organization (WHO) proposed that the ideal cesarean section (CS) rate should be 10%-15%, but over the past 30 years, the CS rate has gradually increased worldwide [1]
Wang et al [6] observed that abnormal symptoms of CS scar diverticulum (CSD) were related to the width (W) of the scar defect but were unrelated with the residual myometrium thickness (RMT) and scar defect depth (D), and later agreed that the equation RMT/ðRMT + DÞ offers additional information on the correlation between defect size and clinical symptoms [9]
This was a retrospective study of patients with CSD treated with vaginal repair between January 2014 and February 2016 at the Shanghai First Maternity and Infant Hospital affiliated to Tongji University
Summary
In 1985, the World Health Organization (WHO) proposed that the ideal cesarean section (CS) rate should be 10%-15%, but over the past 30 years, the CS rate has gradually increased worldwide [1]. Despite the fact that CS is often necessary to save the neonate and the mother, many CS are performed for nonmedical reasons [2]. This is of concern because CS can result in many complications such as uterine rupture during the following pregnancy, chronic pelvic pain, and CS scar diverticulum (CSD) [3, 4]. CSD can cause prolonged menstrual period, menorrhagia, dysmenorrhea, and infertility [5, 6]. Vaginal repair of CSD is a common surgical method to restore the uterine anatomical morphology. Wang et al [6] observed that abnormal symptoms of CSD were related to the width (W) of the scar defect but were unrelated with the residual myometrium thickness (RMT) and scar defect depth (D), and later agreed that the equation RMT/ðRMT + DÞ offers additional information on the correlation between defect size and clinical symptoms [9]
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