Risk Factors Of Cesarean Scar Diverticulum At 6 Weeks After Cesarean Section ——A Prospective Cohort Study

Objective:To investigate the risk factors for cesarean scar diverticulum（CSD）formation at 6 weeks after cesarean section.Methods:A prospective case-control study was used to count a total of 375 women who underwent cesarean delivery in the obstetrics department of Chaohu Hospital of Anhui Medical University,between October 30,2020 and April 30,2021,and 237 women who came to the hospital for review 6 weeks after surgery were collected;CSD was diagnosed based on the results of vaginal ultrasound（TVUS）,63 patients were diagnosed with CSD and served as the observation group,and the other 174 patients who were not diagnosed with CSD was diagnosed as the observation group,and the other 174 patients who were not diagnosed with CSD served as the control group.The specific information of the registered mothers can be briefly summarized as follows:preoperative,intraoperative,postoperative,and 6-week postpartum review conditions.（1）Preoperative conditions:real age,number of previous pregnancies,number of cesarean deliveries,preoperative body mass index（BMI）,weight gain during pregnancy,week of delivery,premature rupture of membranes,gestational combined diabetes,hypertensive disorders in pregnancy,gestational combined thyroid disorders,gestational combined anemia,and preoperative cervical dilatation.（2）Intraoperative conditions:emergency surgery,operation time,lower uterine segment thickness,twin pregnancies,amniotic fluid contamination,fetal birth weight（3）Postoperative conditions:routine blood indicators（specifically white blood cells,platelets,hemoglobin,neutrophils,monocytes,lymphocytes）48 hours after surgery,maximum body temperature within three days after surgery,postpartum hemorrhage,indication for surgery,number of days in hospital,total hospitalization cost（4）Postpartum review at 6 weeks:posterior uterus,uterine reversion,cesarean scar diverticulum.Statistical methods:the measurement data were expressed using x±s,the count data were expressed as rate or ratio,and the type of data analyzed,the analysis of the measurement data was performed by two independent samples t-test with Mann-Whitney U test,the count data were analyzed by chi-square test,and the risk factors of CSD were analyzed by multi-factor logistic regression.The data analysis and processing software applied was SPSS 22.0 software.Results:（1）The prevalence of cesarean scar diverticulum at 6 weeks after cesarean section in our hospital was 26,5%.（2）Age,previous pregnancy,body mass index（BMI）before delivery,week of delivery,combined thyroid disease in pregnancy,emergency surgery,time of surgery,lower uterine segment thickness,twin pregnancy,amniotic fluid contamination,fetal birth weight,uterine reversion,lymphocyte count,monocyte count,hemoglobin volume,platelet count within 48 hours postoperatively,three days postoperatively No statistical differences were found when comparing the observed indicators such as maximum body temperature,postpartum hemorrhage,indication for surgery,days of hospitalization,and total hospitalization cost（p>0.05）.（3）Observed indicators such as multiple cesarean deliveries,weight gain duringpregnancy,hypertensive disorders during pregnancy,premature rupture of membranes,gestational combined diabetes,preoperative cervical dilatation,gestational combined anemia,postoperative white blood cell count within 48 hours,postoperative neutrophil count within 48 hours,and posterior uterine position were associated with the formation of CSD（p<0.05）,（4）Multi-factor logistic regression analysis revealed that premature rupture of membranes,gestational combined diabetes,hypertensive disorders in pregnancy,gestational combined anemia,posterior uterine tilt,and multiple cesarean deliveries were risk factors for CSD formation（p<0.05,OR value>1.0,95%CI lower limit>1）.Conclusion:Premature rupture of membranes,gestational diabetes mellitus,gestational hypertensive disorders,gestational anemia,posterior uterine tilt,and multiple cesarean deliveries are all risk factors for the formation of cesarean scar diverticulum（CSD）at 6 weeks after cesarean delivery.