Journal of investigative surgery : the official journal of the Academy of Surgical Research · 2026
Risk Factors and Stratification Analysis of Cesarean Scar Pregnancy in Women with Cesarean Scar Diverticulum.
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Zhu Yuanhong, Ding Jianhong, Liu Manyun, Zhu Chenhao
Аннотация
OBJECTIVE: To identify risk factors for cesarean scar pregnancy (CSP) in women with cesarean scar diverticulum (CSD) and develop a prediction model with risk stratification.
METHODS: This retrospective study included 398 women with CSD and subsequent intrauterine pregnancy (82 CSP; 316 non-CSP). Clinical and sonographic variables were compared. Independent predictors from multivariable logistic regression were used to construct a nomogram. Model performance was assessed using ROC, calibration, decision curve analysis, and bootstrap validation. Risk groups were defined by tertiles of predicted probability.
RESULTS: Compared with controls, the CSP group had larger niche length and depth, thinner residual myometrium, shorter cesarean interval, and lower early log(hCG) and progesterone (all p < 0.05). Independent predictors were cesarean interval (OR = 0.812), niche length (OR = 1.235), niche depth (OR = 2.129), residual myometrium thickness (OR = 0.326), log(hCG) (OR = 0.445), and progesterone (OR = 0.830). The model showed excellent discrimination (AUC = 0.970, 95% CI: 0.954-0.983). CSP incidences were 0.0%, 0.8%, and 60.9% in the low-, medium-, and high-risk groups, respectively.
CONCLUSIONS: Morphological defect severity, short interpregnancy interval, and low early-pregnancy hormone levels were associated with CSP risk in women with CSD. The model may support early risk stratification and clinical management.
METHODS: This retrospective study included 398 women with CSD and subsequent intrauterine pregnancy (82 CSP; 316 non-CSP). Clinical and sonographic variables were compared. Independent predictors from multivariable logistic regression were used to construct a nomogram. Model performance was assessed using ROC, calibration, decision curve analysis, and bootstrap validation. Risk groups were defined by tertiles of predicted probability.
RESULTS: Compared with controls, the CSP group had larger niche length and depth, thinner residual myometrium, shorter cesarean interval, and lower early log(hCG) and progesterone (all p < 0.05). Independent predictors were cesarean interval (OR = 0.812), niche length (OR = 1.235), niche depth (OR = 2.129), residual myometrium thickness (OR = 0.326), log(hCG) (OR = 0.445), and progesterone (OR = 0.830). The model showed excellent discrimination (AUC = 0.970, 95% CI: 0.954-0.983). CSP incidences were 0.0%, 0.8%, and 60.9% in the low-, medium-, and high-risk groups, respectively.
CONCLUSIONS: Morphological defect severity, short interpregnancy interval, and low early-pregnancy hormone levels were associated with CSP risk in women with CSD. The model may support early risk stratification and clinical management.