Clinical Analysis Of 228 Cases Of Scar Diverticulum And Study On Its Effect On The Expression Of Inflammation Related Molecules In Endometrium

Objectives: To analyze the associated factor with caesarean scar defect(CSD)and the relationship between CSD and infertility,and to evaluate the effect of surgical treatment of abnormal uterus bleeding caused by CSD.Methods: 228 patients who visited Xiamen maternal and child health hospital from January 1,2012 to December 31,2018 and had a history of cesarean section,performed by Xiamen maternal and child health hospital,were diagnosed as CSD by hysteroscopy and wereselected as the research objects(CSD group).In the same period,288 patients whohadahistory of cesarean section,performed by Xiamen maternal and child health hospital,were excluded from CSD by hysteroscopy and were selected as control(control group).Observation indicators include: general condition(age,body mass index(BMI),working condition,uterine position,times of caesarean delivery,times of abortion before the last cesarean section),preoperative condition of caesarean section(hemogram,duration of pregnancy,emergency or elective surgery,in labor or not,duration of labor,cervical dilatation),condition during caesarean section(duration of surgery,bleeding volume of surgery,fetal presentation,neonatal weight),postoperative condition(fever,hemogram after surgery,duration of lochia whether more than 42 days,menstrual recovery time after delivery),complications(anemia,gestational diabetes mellitus(GDM),premature rupture of membranes,gestational hypertension disease,puerperal infection,placenta previa),infertility or not,condition of surgical treatment of CSD(surgical method,duration of surgery,bleeding volume of surgery,curative effect).The general conditions,preoperative conditions of caesarean section,condition during caesarean section,postoperative conditions of caesarean section and complications of the CSD group and the control group were compared,and further logistic regression was used to analyze the influencing factors for the formation of CSD.To compare the difference of infertility prevalence between CSD group and control group.Results:1.Risk factors for the formation of CSD include: retroflexed uterus(OR,161.037;95% CI,42.623-608.425;P=0.000),times of cesarean section(OR,2.878;95% CI,1.521-5.447;P=0.001),duration of surgery(OR,1.042;95% CI,1.007-1.079;P=0.019),head presentation(OR,4.142;95% CI,1.530-11.215;P=0.005),and protective factors included: BMI(OR,0.876;95% CI,0.785-0.977;P=0.018),menstrual recovery time after delivery(OR,0.516;95% CI,0.435-0.0.612;P <0.001).The incidence of CSD was 33.0% in the first cesarean section,67.1% in the second and 83.3% in the third;2.The incidence of infertility was 5.3% in the control group and 13.2% in the CSD group,with statistically significant differences(P<0.05).3.Among the 228 patients with CSD,14 received surgical treatment due to prolonged menstrual period,with an effective rate of 100% and a cure rate of 57.1%.Conclusions: 1.BMI and menstrual recovery time are protective factors for the formation of CSD,retroflexed uterus,times of cesarean section,duration of surgery,head presentation are risk factors for the formation of CSD;2.CSD is the cause of female secondary infertility;3.Hysteroscopic surgery,vaginal surgery and laparoscopic surgery are safe and effective in the treatment of abnormal uterus bleeding induced by CSD.Objectives: To explorethe effect of CSD on the expression of NF-κB,IL-1β,IL-6 m RNAin endometrialtissue.Methods: 16 CSDpatients diagnosed byhysteroscopy from January 2019 to December 2019 in Xiamen maternal and child health care hospital were selected as the CSD group(n=16),16 non-CSD patients in the same period were selected as the control group(n=16).Endometrial specimens were obtained from the CSD group and the control group by endometrial biopsy.q RT-PCR was used to measure the m RNA expression levels of NF-κB,IL-1β,IL-6 in the CSD group and the control group,and the differences between the two groups were compared.Results: Expression levels of NF-κB,IL-1β mRNA in the CSD group were higher than those in the control group,and the difference was statistically significant(P < 0.05),while m RNA expression levels of IL-6 were not statistically significant between the two groups(P> 0.05).Conclusions: The expression of NF-κB and IL-1β m RNA in endometrial tissues of CSD patients was increased.CSD may cause endometritiswhichmayberelatedtofemale secondary infertility,dysmenorrhea,pelvic pain and other symptoms.