| Purpose:Retrospective analysis of the clinical data of patients diagnosed previous cesarean scar defect(PCSD)by transvaginal ultrasound,to explore the characteristics,occurrence factors and clinical features of PCSD,to provide standardized diagnosis and treatment of PCSD clinical basis.Methods:A total of 4,550 patients with a history of cesarean section who underwent transvaginal ultrasound examinations at the gynaecological clinic of the First Hospital of Jilin University between November 2017 and October 2018 were collected.The patient’s age,number of cesarean section,cesarean section time,uterine location,ultrasound characteristics,clinical manifestations and other clinical data were collected.The database was established by using Excel software.The case data were analyzed by retrospective analysis.SPSS 21.0 software was used for statistical analysis,the measurement data were analyzed by ANOVA and the count data were analyzed by χ2 test,p<0.05 was statistically significant.Results:1.4550 cases of women with a history of cesarean section,445 cases were diagnosed as previous cesarean scar defect by Three-dimensional transvaginal ultrasonography,and 16 were diagnosed as cesarean scar pregnancy(CSP)after previous cesarean scar defect,a total of 461 cases(10.1%).Ultrasound images are characterized by incomplete mucosal layer in the lower part of the uterine cavity,discontinuous muscle layer,partial or total loss,and a dark liquid area of the non-plastic fluid is connected with the uterine cavity.2.461 patients with PCSD and combined CSP were 22-60 years old,with an average age of(35.89±5.89)years,including 290 cases of 30-39 years old,accounting for 62.9%.3.Divided into 4 groups according to the time of examination time and cesarean section.There were 3094 patients with cesarean section in 1-10 years,377 patients(12.4%)with PCSD;1662 patients with cesarean section in 11-20 years,148 patients(8.9%)with PCSD;There were 242 patients with cesarean section in 21-30 years group,12 patients with PCSD(5.0%),33 patients with cesarean section in 31-40 years,and 3 patients with PCSD(9.1%).Obviously,the number of cesarean section and the number of PCSD showed an upward trend in recent years,and there was a significant correlation between them(P=0.012).4.Among 4,550 women with a history of cesarean section,380 cases of PCSD in once cesarean section,the incidence rate was 9.3%;77 cases of PCSD in twice cesarean section,the incidence rate was 16.3%,4 cases of PCSD in thrice cesarean section,the incidence rate was 80.0%.The incidence of different cesarean section was compared in the incidence of PCSD,the difference was statistically significant(P<0.05),and the incidence of PCSD increased with the number of cesarean section..5.Among 4,550 women with a history of cesarean section,2968 cases were anterior uterus,including 251 cases of PCSD(8.46%);1456 cases were posterior uterus,of which 199 cases were PCSD(13.7%);126 cases were horizontal uterus,of which 11 cases were PCSD(8.7%).The incidence of PCSD in different uterine locations was statistically significant(χ2 = 29.398,P = 0.000).The incidence of PCSD in the posterior uterus was significantly higher than that in the anterior and horizontal uterus.There was no significant difference in the incidence of PCSD between the anterior uterus and the horizontal uterus.6.Three-dimensional transvaginal ultrasound measurement of 445 cases of PCSD residual muscle layer thickness range of 0-12mm(0mm that ultrasound prompts no muscle layer tissue,only the remaining plasma membrane layer),the average(3.78 ± 1.71)mm,the median is 4mm.According to the thickness of the remaining muscle layer,the 445 patients were divided into two groups,≤2.2mm was a severe PCSD,a total of 108 cases,accounting for 24.3%;≥2.2mm was a light PCSD, a total of 337 cases,accounting for 75.7%.7.Among 445 patients with PCSD,88 patients had a severe PCSD in one cesarean section,accounting for 23.9%;2 patients had a severe PCSD in 2 cesarean section,accounting for 23.3%;3 patients had a severe PCSD in 3 cesarean section,accounting for 75.0%.There was no significant difference between the two groups(P > 0.05).8.Among 445 patients with PCSD,among the 244 patients with anterior uterus,27 cases were severe PCSD,accounting for 11.2%;of the 190 patients with posterior uterus,79 patients with severe PCSD,accounting for 42.6%;11 patients with horizontal uterus,2 cases of severe PCSD,accounting for 18.2%.There was a statistically significant difference in the severe PCSD between different uterine locations(χ2 = 53.881,P = 0.000).The severe PCSD in the posterior uterus was higher than that in the anterior and horizontal uterus.There was no significant difference in the severe PCSD in the anterior uterus and the horizontal uterus.9.Among 445 patients with PCSD,190 cases of emergency cesarean section were performed,including 48 cases of severe PCSD(25.2%);255 cases of elective cesarean section,including 60 cases of severe PCSD(23.5%).There was no significant difference in the incidence of severe PCSD between different caesarean sections(P >0.05).10.Of the 445 patients with PCSD,108 were in the severe PCSD,50 had clinical symptoms(46.3%),337 were in the mild PCSD,and 76 had clinical symptoms(22.6%).The incidence of clinical symptoms was compared between the different types of PCSD,and the difference was statistically significant(χ2 = 22.718,P = 0.000).11.Among 445 patients with PCSD,368 cases of cesarean section were performed in one case,including 106 cases with clinical symptoms,accounting for28.8%;73 cases with twice cesarean section,and 18 cases with clinical symptoms,accounting for 24.7%;4 cases with trice times cesarean section and 2 cases with clinical symptoms,accounting for 50.0%.There was no significant difference in the incidence of clinical manifestations between different cesarean sections(P > 0.05).12.Of the 445 patients with PCSD,244 were in the anterior uterus,including 63 in clinical symptoms(25.8%);190 in the posterior uterus,including 60 in clinical symptoms(31.6%);11 in the uterus There were 3 cases with clinical symptoms(27.3%).There was no significant difference in the incidence of clinical manifestations between different uterine locations(P > 0.05).13.4550 women with a history of cesarean section,16 cases were diagnosed as CSP by three-dimensional transvaginal ultrasound,accounting for 0.35% of the patients with history of cesarean section,and 3.5% of PCSD.The mean age of the patients with CSP were 37.45±4.31 years old,the pregnancy rate of cesarean section scars between different cesarean sections was not statistically significant(χ2 = 0.786,P = 0.375).There was no significant difference in the incidence of pregnancy between the cesarean section scars at different uterine locations(χ2 = 0.973,P =0.324).Conclusions:1.Three-dimensional transvaginal ultrasonography has a high diagnostic value for PCSD,and it is the preferred method of examination because of its convenience,non-invasiveness and reproducibility.2.The high age of onset of PCSD is 30-39 years old.With the increase of the number of cesarean section,the number of PCSD increases,and there is correlation.3.The location of the uterus,the number of cesarean section and the incidence of PCSD are related,the incidence of PCSD in women with posterior uterus and multiple cesarean section is higher.4.PCSD has no characteristic clinical manifestations,and the clinical manifestations of larger PCSD are more obvious,mainly characterized by irregular vaginal bleeding.There was no correlation between the number of cesarean section,uterine position and clinical manifestations.5.The posterior uterus is more likely to form a larger PCSD,the number of cesarean section and the timing of cesarean section have nothing to do with the size of PCSD... |
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