Value and influencing factors of preoperative MRI evaluation for previous cesarean scar defect associated abnormal uterine bleeding in patients undergoing laparoscopic surgery.

2 As the cesarean section rate increases year by year the treatment of previous cesarean scar defects (PCSD) poses a significant challenge. This study aims to evaluate the clinical value of preoperative magnetic resonance imaging (MRI) technology and analyze relevant influencing factors for patients with abnormal uterine bleeding (AUB) associated with cesarean scar defects who underwent laparoscopic surgery.

2 A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology the Third Xiangya Hospital of Central South University from 2018 to 2022. A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status: The clinically-cured group ( n =28 49.1%) and the non-clinically-cured group ( n =29 50.9%). After a postoperative follow-up period of 3 months for all participants logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors. These factors included patient age clinical symptoms obstetric history history of cesarean section basic clinical information preoperative MRI parameters and postoperative menstrual conditions.

2 There were no significant differences in many aspects including the patient’s age at the time of previous cesarean section number of pregnancy time since the previous cesarean section the uterus position assessed by preoperative T 2 signal MRI defect length defect width residual muscle layer thickness adjacent uterine muscle layer thickness and distance from the defect to the external cervical os between the 2 groups (all P > 0.05). However the time of onset of AUB symptoms ( P =0.036 OR=1.019 95% CI 1.002 to 1.038) and the depth of the defect on the preoperative MRI ( P =0.010 OR=5.793 95% CI 1.635 to 25.210) were identified as risk factors affecting the clinical cure rate.

2 The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD which could be helpful for evaluating the prognosis of disease. Betran AP , Ye J , Moller AB , et al . Trends and projections of caesarean section rates: global and regional estimates [J/OL]. BMJ Glob Health , 2021 , 6 ( 6 ): e 005671 [ 2023-03-20 ]. https://doi.org/10.1136/bmjgh-2021-005671 https://doi.org/10.1136/bmjgh-2021-005671 . Song C , Xu Y , Ding Y , et al . The rates and medical necessity of cesarean delivery in China, 2012-2019: an inspiration from Jiangsu [J]. BMC Med , 2021 , 19 ( 1 ): 14 . https://doi.org/10.1186/s12916-020-01890-6 https://doi.org/10.1186/s12916-020-01890-6 . Li HT , Hellerstein S , Zhou YB , et al . Trends in cesarean delivery rates in China, 2008-2018 [J]. JAMA , 2020 , 323 ( 1 ): 89 - 91 . https://doi.org/10.1001/jama.2019.17595 https://doi.org/10.1001/jama.2019.17595 . Sandall J , Tribe RM , Avery L , et al . Short-term and long-term effects of caesarean section on the health of women and children [J]. Lancet , 2018 , 392 ( 10155 ): 1349 - 1357 . https://doi.org/10.1016/S0140-6736(18)31930-5 https://doi.org/10.1016/S0140-6736(18)31930-5 . Bij De Vaate AJ , Van Der Voet LF , Naji O , et al . Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review [J]. Ultrasound Obstet Gynecol , 2014 , 43 ( 4 ): 372 - 382 . https://doi.org/10.1002/uog.13199 https://doi.org/10.1002/uog.13199 . Murji A , Sanders AP , Monteiro I , et al . Cesarean scar defects and abnormal uterine bleeding: a systematic review and meta-analysis [J]. Fertil Steril , 2022 , 118 ( 4 ): 758 - 766 . https://doi.org/10.1016/j.fertnstert.2022.06.031 https://doi.org/10.1016/j.fertnstert.2022.06.031 . Stegwee SI , Beij A , De Leeuw RA , et al . Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature [J]. Qual Life Res , 2020 , 29 ( 4 ): 1013 - 1025 . https://doi.org/10.1007/s11136-019-02376-6 https://doi.org/10.1007/s11136-019-02376-6 . Chen H , Wang Y , Zhang H , et al . Vaginal repair of cesarean section scar defects: Preoperative hysteroscopic evaluation [J]. Acta Obstet Gynecol Scand , 2022 , 101 ( 11 ): 1308 - 1314 . https://doi.org/10.1111/aogs.14429 https://doi.org/10.1111/aogs.14429 . Bij De Vaate AJ , Brolmann HA , Van Der Voet LF , et al . Ultrasound evaluation of the cesarean scar: relation between a niche and postmenstrual spotting [J]. Ultrasound Obstet Gynecol , 2011 , 37 ( 1 ): 93 - 99 . https://doi.org/10.1002/uog.8864 https://doi.org/10.1002/uog.8864 . Jordans IPM , De Leeuw RL , Stegwee SI , et al . Niche definition and guidance for detailed niche evaluation [J]. Acta Obstet Gynecol Scand , 2019 , 98 ( 10 ): 1351 - 1352 . https://doi.org/10.1111/aogs.13623 https://doi.org/10.1111/aogs.13623 . Donnez O , Donnez J , Orellana R , et al . Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women [J]. Fertil Steril , 2017 , 107 ( 1 ): 289 - 296 e2 [ 2023-03-20 ]. https://doi.org/10.1016/j.fertnstert. 2016.09.033 https://doi.org/10.1016/j.fertnstert.2016.09.033 . Zhang Q , Lei L , Zhang A , et al . Comparative effectiveness of laparoscopic versus hysteroscopic approach in patients with previous cesarean scar defect: a retrospective cohort study [J]. Ann Transl Med , 2021 , 9 ( 20 ): 1529 . https://doi.org/10.21037/atm-21-4339 https://doi.org/10.21037/atm-21-4339 . Donnez O . Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased [J]. Fertil Steril , 2020 , 113 ( 4 ): 704 - 716 . https://doi.org/10.1016/j.fertnstert.2020.01.037 https://doi.org/10.1016/j.fertnstert.2020.01.037 . Antila-Langsjo RM , Maenpaa JU , Huhtala HS , et al . Cesarean scar defect: a prospective study on risk factors [J/OL]. Am J Obstet Gynecol , 2018 , 219 ( 5 ): 458 e1 - e8 [ 2023-03-06 ]. https://doi.org/10.1016/j.ajog.2018.09.004 https://doi.org/10.1016/j.ajog.2018.09.004 . De Luget CD , Becchis E , Fernandez H , et al . Can uterine niche be prevented? [J]. J Gynecol Obstet Hum Reprod , 2022 , 51 ( 3 ): 102299 . https://doi.org/10.1016/j.jogoh.2021.102299 https://doi.org/10.1016/j.jogoh.2021.102299 . Tanimura S , Funamoto H , Hosono T , et al . New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect [J]. J Obstet Gynaecol Res , 2015 , 41 ( 9 ): 1363 - 1369 . https://doi.org/10.1111/jog.12738 https://doi.org/10.1111/jog.12738 . Chen YY , Tsai CC , Kung FT , et al . Association between hysteroscopic findings of previous cesarean delivery scar defects and abnormal uterine bleeding [J]. Taiwan J Obstet Gynecol , 2019 , 58 ( 4 ): 541 - 544 . https://doi.org/10.1016/j.tjog. 2019.05.020 https://doi.org/10.1016/j.tjog.2019.05.020 . Vervoort A , Vissers J , Hehenkamp W , et al . The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study [J]. BJOG , 2018 , 125 ( 3 ): 317 - 325 . https://doi.org/10.1111/1471-0528.14822 https://doi.org/10.1111/1471-0528.14822 . Donnez O , Jadoul P , Squifflet J , et al . Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section [J]. Fertil Steril , 2008 , 89 ( 4 ): 974 - 980 . https://doi.org/10.1016/j.fertnstert.2007.04.024 https://doi.org/10.1016/j.fertnstert.2007.04.024 . Verberkt C , Jordans IPM , Van Den Bosch T , et al . How to perform standardized sonographic examination of uterine niche in non-pregnant women [J]. Ultrasound Obstet Gynecol , 2022 , 60 ( 3 ): 420 - 424 . https://doi.org/10.1002/uog.24953 https://doi.org/10.1002/uog.24953 . Fiocchi F , Petrella E , Nocetti L , et al . Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging [J]. Radiol Med , 2015 , 120 ( 2 ): 228 - 238 . https://doi.org/10.1007/s11547-014-0431-y https://doi.org/10.1007/s11547-014-0431-y . Yao M , Wang W , Zhou J , et al . Cesarean section scar diverticulum evaluation by saline contrast-enhanced magnetic resonance imaging: The relationship between variable parameters and longer menstrual bleeding [J]. J Obstet Gynaecol Res , 2017 , 43 ( 4 ): 696 - 704 . https://doi.org/10.1111/jog.13255 https://doi.org/10.1111/jog.13255 . 查看原文 0 浏览量 139 下载量 0 CSCD 工具集 下载 - 网络PDF下载 参考文献导出 - BibTeX下载 - Endnote下载 - RefMan 下载 - NoteExpress下载 - NoteFirst下载 分享 分享给微信好友或者朋友圈 收藏 添加至我的专辑 关联资源 相关文章 暂无数据 相关作者 暂无数据 相关机构 暂无数据 选择翻译语言 - 地址：湖南省长沙市湘雅路110号中南大学开福校区（湘雅医学院老校区）75号信箱 邮编：410078 - 联系电话：0731-84805495 Email：[email protected] - 技术支持由北京北大方正电子有限公司提供 湘ICP备05005659号-1 京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式 - Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies 0 批量引用 导出至 BibTeXEndnoteRefManNoteExpressNoteFirst 回到顶部