Analysis On Influencing Factors For Previous Cesarean Scar Defect

Objectives To analyze factors for previous cesarean scar defect(PCSD).Methods Selected 902 cases after cesarean section in north China university of science and technology affiliated hospital from April 2014 to December 2015, 50 cases with PCSD as the case group, 102 cases without PCSD as the control group. Observation indexes including:(1)General conditions during pregnancy: age, gestational age, prenatal body mass index(BMI), neonatal weight.(2)Perioperative conditions: premature rupture of membranes, Pregnancy complications, cesarean delivery time, the operation opportunity, bleeding, the number of white blood cell and anemia.(3)Uterine scar: number of cesarean section and the time interval from the last cesarean section.(4)Ultrasonic situation after delivery: position of the uterus, uterine incision healing for 7 days, size of the uterus for 42 days, intrauterine separation and the formation of previous cesarean scar defect.(5)Formation of the lower uterine segment in intraoperative exploration.(6)Healing of previous uterine incision in intraoperative exploration. Based on the above indicators, analyzed the difference of clinical data of the case group and the control group, the consistency of PCSD and uterine incision healing for 7 days, the differences in the different operation opportunity and healing of previous uterine incision between case and control group, and analyzed the difference in different healing of previous uterine incision and time since last cesarean.Results 1 Age and the proportion of pregnancy complications, the number of white blood cell abnormally elevated, scarred uterus, posteria uterus, intrauterine separation in the case group were higher than the control group(P<0.05), and the OR>1, the minimum value of 95% CI>1. Multiariable Logistic regression analysis at the same time, pregnancy complications, the number of white blood cell abnormally elevated, and scarred uterus, eventually entered the regression equation(P<0.05), that is those were the risk factors of PCSD. 2 The difference was not statistically significant beteewn early incision healing after cesarean section and PCSD(P>0.05), but the degree of matching was statistically significant(Kappa=0.416, P=0.000), that is early incision healing after cesarean section was consistent with PCSD. 3 The proportion of poor formation of the lower uterine in the patient group was higher than the control group(P<0.05), and the OR>1, the minimum value of 95% CI>1, that is poor formation of the lower uterine was a risk factor of PCSD; Comparison of case and control groups, the operation opportunity was different, and the difference was statistically significant(P<0.05); compared the differences in different operation opportunity(undergoing elective surgery, undergoing surgery as cervixas expanding<3cm,and undergoing surgery as cervixas expanding≥3cm), in the case group, the proportion of undergoing surgery as cervixas expanding≥3cm and undergoing elective surgery were higher, and the difference was statistically significant(P<0.017). 4 The proportion of poor healing of previous uterine incision and time since last cesarean≥5 years were higher in the patient group than the control group(P<0.05), and the OR>1, the minimum value of 95% CI>1, that is poor healing of previous uterine incision and time since last cesarean≥5 years were the risk factors of PCSD, in contrast, well healing of previous uterine incision and time since last cesarean in 2~5 years were the protective factors of PCSD.Conclusions 1 The formation of PCSD may be related to pregnancy complications, the number of white blood cell abnormally elevated, scarred uterus and early incision healing after cesarean section. 2 Undergoing elective surgery and surgery as cervixas expanding≥3cm increases the proportion of poor formation of the lower uterine, and increases the incidence of PCSD. 3 Time since last cesarean>5 years increases the proportion of uterine incision healing, and increases the incidence of PCSD.