[Analysis of influencing factors for abnormal uterine bleeding due to cesarean scar diverticulum].

Objective

To study the influencing factors for abnormal uterine bleeding (AUB) due to cesarean scar diverticulum (CSD).

Methods

Clinical data were collected from all 7 007 patients of reproductive age who underwent outpatient hysteroscopy between June 2018 and November 2019 in the Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients diagnosed with CSD by hysteroscopy under B-ultrasound monitoring were selected and divided into the AUB group and the non-AUB group according to whether they presented with AUB. SPSS 26.0 was used to analyze the factors affecting AUB in the two groups, and to analyze the risk factors for AUB in patients with CSD by multifactorial binary logistic regression. The predictive value of residual myometrial thickness for AUB was analyzed using the receiver operating characteristic (ROC) curve.

Results

(1) After inclusion and exclusion criteria, a total of 686 patients with CSD were included in this study, including 469 patients in the AUB group and 217 patients in the non-AUB group. There were statistically significant differences in age, residual myometrial thickness, length of CSD, whether combined with chronic endometritis, number of cesarean deliveries and time from last cesarean to hysteroscopy (all P<0.05). (2) Multivariate binary logistic regression analysis showed that residual myometrial thickness (OR=0.586, 95%CI: 0.488-0.704), length of CSD (OR=1.927, 95%CI: 1.086-3.421), whether combined with chronic endometritis (OR=1.537, 95%CI: 1.028-2.299) and number of cesarean deliveries (OR=2.020, 95%CI: 1.223-3.335) were independent influencing factors for AUB due to CSD (all P<0.05). (3) The area under the ROC curve for residual myometrial thickness to predict AUB was 0.670, and the cut-off value for residual myometrial thickness was 2.95 mm. All the 686 patients were divided into two groups based on the cut-off value of residual myometrial thickness, and the risk of AUB in patients with residual myometrial thickness≤2.95 mm was 2.582 times higher than that in patients with residual myometrial thickness>2.95 mm (OR=2.582, 95%CI: 1.853-3.599). The difference was statistically different (P<0.001).

Conclusions

Reduced residual myometrial thickness, increased CSD length, combined chronic endometritis, and increased number of cesarean deliveries may significantly increase the risk of AUB due to CSD. For patients with the combination of these risk factors, treatment requires comprehensive assessment and individualized selection of treatment options. The likelihood of residual myometrial thickness≤2.95 mm due to iatrogenic factor should be reduced in order to reduce the risk of AUB in patients with CSD and improve their prognosis.