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| Predictive value of ultrasonic parameters of cesarean scar diverticulum at different time points after cesarean section for their irregular vaginal bleeding |
| The First People's Hospital of Yongkang, Zhejiang Province, 321300 |
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Abstract To analyze the predictive value of ultrasonic parameters of cesarean scar diverticulum（CSD）of patients at different time points for their irregular vaginal bleeding after cesarean section. Methods: From January 2017 to June 2019，the puerpera with CSD during postpartum rehabilitation examination were selected as the study subjects. Transvaginal ultrasonography was performed on these puerpera in the postpartum 42th day，in the postpartum 6th month，and in the postpartum 12th month, respectively. These puerpera with CSD in the postpartum 12th month were divided into group A (the puerpera with clinically symptoms) and group B (the puerpera without clinically symptoms) according to whether irregular vaginal bleeding occurred during the followed up period. The ultrasonic parameters values of the puerpera at different postoperative time point of CSD were compared between the two groups. The correlation of the ultrasonic parameters values of the puerperal and their irregular vaginal bleeding was analyzed, and the value of the ultrasonic parameters of the puerpera for predicting the irregular vaginal bleeding was also analyzed. Results: There were no significant differences in the values of the diverticulum width and depth, and the ratio of width to depth of the diverticulum, and the value of the residual uterine muscle thickness and the ratio of the residual muscle thickness in the postpartum 42th day of the puerpera between group A and group B (P>0.05). The value of diverticulum depth and the proportion of ratio of width to depth of the diverticulum≤1 of the puerpera in group A in the postpartum 6th month were significantly higher than those of the puerpera in group B, and the values of the residual uterine muscle thickness and the residual muscle thickness ratio of the puerpera in group A in the postpartum 6th month were significantly lower than those of the puerpera in group B (P<0.05). There was no significant difference in the diverticulum width of the puerpera between group A and group B (P>0.05). The ratio of width to depth diverticulum ≤1 and the ratio of the residual muscle thickness <0.65 of the puerpera were the independent influencing factors of their irregular vaginal bleeding occurrence (P<0.05). The ratio of width to depth diverticulum ≤1 and the ratio of the residual muscle thickness of the puerpera in the postpartum 12th month had predictive value for irregular vaginal bleeding, and the area under the curve (AUC) of which were 0.822 and 0.701, the sensitivity of which were 58.7% and 64.4%, and the specificity of which were 80.4% and 65.9%. Conclusion: The parameters of CSD by ultrasound of the puerpera are related to their symptoms of postpartum irregular vaginal bleeding, and the parameters of CSD by ultrasound in the postpartum 12th month have higher predictive value for postpartum irregular vaginal bleeding.
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