Prevalence of and Factors Associated with Large Cesarean Scar Defects in Women at Six Weeks Postpartum; [ความชุกและปัจจัยที่สัมพันธ์กับร่องแผลเป็นมดลูกขนาดใหญ่จากการผ่าคลอดที่ หกสัปดาห์หลังคลอดบุตร]

Abstract

Objectives: To demonstrate the prevalence and factors associated with a large Cesarean scar defect (CSD) in Thai postpartum women. Materials and Methods: This was a cross-sectional study. The participants were enrolled for a postpartum sonographic examination at the sixth-week follow-up from August to December 2021. CSD was measured using a two-dimensional transvaginal ultrasound device. A large CSD was defined as having a height of ≥ 50% of the total myometrial thickness. The sonographer was blinded to the obstetric history until all parameters had been recorded. Results: At six weeks postpartum, CSD was identified in 94 participants. There were 64 and 30 participants in the primary and repeat Cesarean section (CS) groups, respectively. The overall prevalence of large CSD was 22.3%. A large CSD was seen in 15.6% (10/64) and 36.7% (11/30) of the patients in the primary and repeated CS groups. The factors associated with large CSD were repeated CS (p = 0.002), cervical dilatation ≥ 6 cm at the time of CS (p = 0.023), and uterine retroflexion (p = 0.015) groups, with odds ratio of 8.85 (95% confidence interval (CI) 2.29-34.15), 5.84 (95%CI 1.28-26.71) and 4.40 (95%CI 1.33-14.55), respectively. Conclusion: The overall prevalence of large CSDs was 22.3%. Repeated CS, uterine retroflexion, and cervical dilatation ≥ 6 cm at the time of CS had higher odds of developing a large CSD. © 2023 Royal Thai College of Obstetricians and Gynaecologists.