A Clinical Study About The Relationship Between Previous Cesarean Scar Defect And Abnormal Uterine Bleeding And The Treatmentoptions Of The Previous Cesarean Scar Defect

[Objectives] To investigate the relationship between the thickness,theposition of the uterine scar and the volume of previous cesarean scar defect with abnormal uterine bleeding(AUB). The best treatment plan of previous cesarean scar defect(PCSD) is discussed in this research.[Methods]1. Weselected a total of 30 patients with PCSD and AUB as Group PCSD-A,a total of 20 patients with PCSD and without AUB as Group PCSD-B,and another 30 patientsafter cesarean delivery withtout PCSD as Group CS.2. All the 3 groups of patients were detected the distancefrom post-cesarean sectionscar defect to the external cervix orifice and innercervix orifice,the thickness of the uterinescar,and diverticularlength, width and heightby transvaginal ultrasound in the first 5-8 days of menstruation.The menstruation and discrepancies of ultrasound data of all the 3 groups of patients before surgerywere observed.3.The patients of Group PCSD-A were randomly divided into 2 groups, in which 15 cases weretreated with hysteroscopy combined with laparoscopy neoplasty(endoscope group), and the other 15 cases were treated with transvaginal neoplasty(transvaginal neoplasty group).3 months after surgery we observed the diverticularvariety and the healing of uterine incision scar by hysteroscopy and transvaginal ultrasound.Details of menstruation and postoperative complications were recorded.[Results]1. The rate of AUBin Group PCSD(all the patients of PCSD)was significantly higher than that in Group CS(P= 0.000).Sgnificant difference can be observed about the menstrual period among 3 groups(P= 0.002).Intermenstrual flow and anemia of Group PCSD-A were statistically different from that of Group CS(P <0.05),but there was no difference about the menstrual cycle and menorrhagia ratio among the 3 groups(P> 0.05).2.The distancesfrom post-cesarean sectionscar defect to the external cervix orifice and innercervix orifice in 3 groups were statistically different(P<0.05),the farthest wasGroup CS and the closestwasGroup PCSD-A. Compared with Group PCSD-B,the diverticularlength, width and height were larger ofGroup PCSD-A( P<0.05).The uterinescar ofGroup PCSD-A was statistically thinner thanthat of GroupPCSD – B and Group CS(P>0.05).3.AUB as the dependent variable, we used the single factor Logistic regression analysis to study the relationship among the thickness of uterine scar,diverticularlength, width,height,the distancesfrom post-cesarean sectionscar defect to the external cervix orifice and innercervix orifice,and AUB. The results showedthat the distancesfrom post-cesarean sectionscar defect to the external cervix orifice and innercervix orifice were the protective factors of AUB.4.Compared with preoperativesituation, the menstrual period in both endoscope group and transvaginal neoplasty groupwere statistically shortenedafter surgery(P<0.05),but there was no difference about the restore of menstruation between the two groups(P> 0.05).The cure rate of endoscope group was statistically higher thanthat of transvaginal neoplasty group(P=0.034).All the patients with mild and moderate PCSD were cured by the 2 kinds of surgical treatment.The cure rate of severe PCSD byendoscope was100%(8/8),while bytransvaginal neoplasty was57.1%(4/7),and they were statistically different(P=0.02).[Conclusions]1.The distances from post-cesarean sectionscar defect to the external cervix orifice and innercervix orifice were the protective factors of AUB.2. There were no significant relationship betweendiverticularlength, width and height with AUB.3. We can cure PCSD byeither endoscope ortransvaginal neoplasty,both of which aresafe, effective, and minimally invasive. However, endoscopeis combined with better prognosis, which is an effective treatment of PCSD.