P-754 Chronic poor healing wounds of post cesarean scar diverticulum: altered angiogenesis and immunobiology

Abstract

Abstract Study question To detect the influences of cesarean section scar diverticula (CSD) on the pregnancy outcomes in ART and explore the mechanisms. Summary answer In the CSD group, the cumulative live birth rate （CLBR） was significantly reduced, accompanied by excessive proliferation of fibroblasts and expansion of vascular proliferation. What is known already Diverticulum can reduce the chances of embryo implantation and may lead to spontaneous miscarriages if the implantation is close to or in the CSD. The accumulation of bloody fluid can be detected in approximately 42% of women with large CSD. The trapped blood is slowly released and could affect cervical mucus, sperm transport, and implantation. The previously data have revealed that disrupted uterus microbiota is closely associated with local inflammatory cytokines which could also be a clue for impaired fecundity in CSD. Study design, size, duration This retrospective cohort study was conducted using data from a single, large university-affiliated fertility center. Data was retrospective analyzed among women underwent ART procedure from May 2010 to March 2021. Follow-up basic experiments to explore relevant mechanisms. Participants/materials, setting, methods Data was retrospective analyzed among 31375 women underwent ART procedure in the Sixth affiliated Hospital of Sun Yat-sen University. To optimize the precision of the study, patients in the CSD group and the NCS group were matched using propensity score matching method. Perform hysteroscopy and obtain cervical swab and endometrial tissue of lower segment. To explore the difference of uterine cavity environment between CSD group and vaginal birth (VB) group by histopathological and immunological analysis. Main results and the role of chance The CS group had significantly lower CLBR compared to NCS group. Histopathological analysis showed that the higher prevalent of chronic endometritis is accompanied by excessive fibroblast proliferation at the lower segment of uterus and significantly exaggerated vascular proliferation in situ. Intrauterine inflammatory cytokines including IL-1α, IL-1β, IL-6, IL-8, TNF-α and SDF-1α were also increased in CSD group. Limitations, reasons for caution The main limitation of our study is its retrospective nature and single center, which might have underestimated the total number of women with CSD and could lead to a bias. Wider implications of the findings Lay emphasis on anti-infective therapy, modulate the imbalance of reproductive tract flora and enhance early lesion healing post-operation are of great necessity. Future studies exploring the preventive and therapeutic strategies of CSD should focus on immune inflammatory response and angiogenesis. Trial registration number Not applicable