February 22nd, 2019

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Risk Factors and Underlying Mechanisms for Postmenstrual Spotting Associated with Cesarean Scar Defect: A Retrospective Study
Authors:  Xian-Qing Wu, Ph.D., Hui Ding, M.D., Mei-Fang Nie, Ph.D., Longzhu Piao, Ph.D., Hong-Wen Zhang, M.D., and S. Joseph Huang, Ph.D.
  OBJECTIVE: To identify risk factors for cesarean scar defect (CSD)–associated postmenstrual spotting and the possible underlying mechanisms.

STUDY DESIGN: A retrospective study. Transvaginal ultrasound was performed in patients with a history of cesarean section to identify CSDs and other uterine diseases. Clinical data of patients with CSDs were collected, including measurements of serum sex and thyroid hormones. In patients with CSD-associated postmenstrual spotting, hysteroscopy was performed.

RESULTS: Enrolled were 121 women with CSDs detected by transvaginal sonography without other uterine diseases or endocrine disorders; 91 of these patients had postmenstrual spotting. Binary logistic regression analyses determined that CSD-associated postmenstrual spotting was related to a retroflexed uterus, closed cervix prior to cesarean, and cesarean performed at a town/county-level hospital as opposed to a province-level hospital. Hysteroscopic findings of CSDs in patients with postmenstrual spotting included polyps, dilated superficial capillaries, residual suture materials, thickened and folded endometrium in the scar, blood accumulation in the uterine cavity, and scar oozing.

CONCLUSION: Risk factors for CSD-associated postmenstrual spotting include a retroflexed uterus, closed cervix prior to cesarean, and cesarean performed at a town- or county-level hospital.
Keywords:  cesarean scar defect, hysteroscopy, mechanisms, postmenstrual spotting, risk factors
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