剖宫产瘢痕缺损(CSD)是剖宫产(CS)后的潜在并发症,具有重要的临床意义,通常通过超声进行临床诊断。然而,CS后超声诊断CSD的最佳时机尚未确定。本研究旨在通过超声检查评估CS后CSD诊断的适当时间。
■这项前瞻性研究涉及2021年1月至2022年6月通过选择性CS分娩的120名妇女,其中单胎和足月分娩。在研究中样本登记是连续的。每位女性在6周时接受了3次超声检查以进行CSD诊断,6个月,根据改良的德尔菲法,产后12个月。记录切口情况的超声指标并进行统计学分析。使用配对4折表格卡方检验来评估3种诊断之间的一致性。使用4细胞表计算诊断灵敏度和特异性。根据诊断是否与6个月或12个月时的诊断一致,将第6周的120例患者分为一致组和不一致组,对超声指标进行统计学评价。此外,还记录了纳入妇女的月经持续时间,以使用Person相关系数分析产后6个月时CSD超声指标的相关性。
■纳入的120名女性分为正常(3-7天,n=52)和月经期延长(>7天,n=68)组。2组年龄差异无统计学意义。体重指数(BMI),分娩的孕周,辅助生殖率,或产后并发症。在120名女性中,100、66和61名妇女在6周时被诊断为CSD,6个月,产后12个月,分别。结果表明,产后6周的诊断结果与6或12个月的诊断结果不一致,但前2例诊断结果一致.6个月的诊断敏感性为100%,特异性为91.53%[95%置信区间(CI):85.84-95.26%]。Further,发现缺陷的深度存在显着差异,6周时,不一致组与一致组之间的残余肌肉厚度(T)和比率。当CS后6周缺损深度等于或小于4.04±0.82mm时,患者可以在6个月时从CSD中自我恢复。此外,在CSD组6个月时,长度(r=0.828,P<0.001),深度(r=0.784,P<0.001),缺损宽度(r=0.787,P<0.001),T(r=0.831,P<0.001)和残余肌肉比率(r=0.821,P<0.001)与月经持续时间密切相关。
■CS后第6周进行CSD评估可能会导致误诊或过度诊断。建议在产后6个月或更长时间后诊断CSD。
UNASSIGNED: Cesarean scar defect (CSD) is a potential complication following cesarean section (CS), which has significant clinical implications, and is usually clinically diagnosed by ultrasound. However, the optimal timing for ultrasound diagnosis of CSD after CS has not been well established. This study aimed to evaluate the appropriate
time for the diagnosis of CSD after CS by ultrasonography.
UNASSIGNED: The prospective study involved 120 women who delivered by elective CS with single birth and term birth from January 2021 to June 2022. Sample enrollment was consecutive in the study. Each woman underwent 3 ultrasound examinations for CSD diagnosis at 6 weeks, 6 months, and 12 months postpartum according to a modified Delphi method. The ultrasound indicators about the incision situation were recorded and statistically analyzed. Paired 4-fold table chi-square test was used to evaluate the consistency between the 3 diagnoses. The diagnostic sensitivity and specificity were calculated using a 4-cell table. According to whether the diagnosis was consistent to that at 6 or 12 months, the 120 cases at week 6 were separated into a consistent group and inconsistent group for statistical evaluation of the ultrasound indicators. Additionally, the menstrual duration of the included women was also recorded to analyze the correlation to ultrasound indicators of CSD at 6 months postpartum using the Person correlation coefficient.
UNASSIGNED: The included 120 women were divided into normal (3-7 days, n=52) and prolonged menstrual period (>7 days, n=68) groups. The 2 groups had no statistical differences in age, body mass index (BMI), gestational week of delivery, assisted reproduction rates, or postpartum complications. Among the 120 women, 100, 66, and 61 women were diagnosed as CSD at 6 weeks, 6 months, and 12 months postpartum, respectively. The results indicated that the diagnostic results of 6 weeks were inconsistent with those of 6 or 12 months postpartum, but the last 2 diagnostic results were consistent. The diagnostic sensitivity of 6 months was 100% and the specificity was 91.53% [95% confidence interval (CI): 85.84-95.26%]. Further, significant differences were found in depth of the defect, and the thickness (T) and ratio of residual muscle between the inconsistent group and the consistent group at 6 weeks. The patients could be considered self-recovered from CSD at 6 months when the defect depth was equal to or less than 4.04±0.82 mm at 6 weeks after CS. Additionally, in the CSD group at 6 months, the length (r=0.828, P<0.001), depth (r=0.784, P<0.001), width (r=0.787, P<0.001) of the defect, the T (r=0.831, P<0.001) and ratio of residual muscle (r=0.821, P<0.001) were strongly correlated with menstrual duration.
UNASSIGNED: CSD evaluation at week 6 after CS may cause misdiagnosis or overdiagnosis. The diagnosis of CSD was suggested to be made following 6 months or longer postpartum.