Clinical Characteristics and Risk Factors of Coexisting Endometrial Lesions in Patients with Cesarean Scar Defect Undergoing Hysteroscopic Resection for Prolonged Menstruation.

OBJECTIVE

To investigate the clinical characteristics of patients with prolonged menstruation treated with hysteroscopic resection of a cesarean scar defect (CSD), and to analyze the high-risk factors for its coexistence with intrauterine pathologies, such as endometrial polyps or endometrial hyperplasia.

METHODS

This retrospective cohort study included 382 patients with prolonged menstruation who underwent CSD resection between January 2023 and December 2024. Based on the presence or absence of concurrent endometrial polyps or hyperplasia, the patients were divided into two groups: the simple CSD group (n=208) and the group with coexisting endometrial pathology (n=174). The definition of endometrial lesions was based on imaging and pathological examination findings, and all diagnoses were made by experienced physicians. Differences in demographics, clinical presentation, imaging parameters, and menstrual improvement were compared. Logistic regression was used to identify independent risk factors for endometrial lesions and develop a predictive model with a nomogram.

RESULTS

Compared with the simple CSD group, patients with coexisting endometrial disease had a higher rate of anemia (33.9% vs 17.3%, p<0.001), lower preoperative medication use (14.9% vs 27.9%, p=0.002), lower preoperative hemoglobin (p<0.001), thicker endometrium (8.4 vs 6.7 mm, p<0.001), slightly larger CSD dimensions, and higher rates of CSD-related cysts and fibroids (all p<0.05). Multivariate analysis identified anemia, lack of preoperative medication, endometrial thickness, and CSD-related cysts as independent predictors. The constructed prediction model showed moderate discrimination with an AUC of 0.710. Menstrual improvement at 6 months postoperatively was comparable between the two groups.

CONCLUSION

Patients with CSD and coexisting endometrial lesions present with more complex intrauterine features and a higher risk of abnormal bleeding. Despite similar short-term outcomes, preoperative identification of endometrial pathology is essential for optimizing treatment strategies and individualized intervention.