Prediction Model for Cesarean Scar Disorder Disappearance After Transvaginal Uterine Diverticulum Repair

Abstract

Objectives

Cesarean scar disorder (CSD) is a recently defined condition resulting from cesarean delivery (CD) surgery, and transvaginal uterine diverticulum repair (TVUDR) is generally chosen for treatment of CSD. This study constructed a prediction model for CSD disappearance after TVUDR using imaging data for CSD measured by transvaginal ultrasound (TVU), MRI, and contrast-enhanced MRI.

Methods

The data of 283 women with previous CD treated with TVUDR were retrospectively collected between January 2014 and February 2016. The imaging data for the CSD parameters were measured, including length, width (W), depth (D), residual myometrium thickness (RMT), RMT/depth (RMT/D), and RMT/(RMT + depth) [RMT/(RMT+D)].

Results

Of the patients included, 129 women presented with disappearance of CSD. We noted potential differences between CSD disappearance and existence after TVUDR for W, RMT, RMT/D, and RMT/(RMT+D) measured by MRI, and D, RMT/D, and RMT/(RMT+D) measured by contrast-enhanced MRI. After adjusting for potential confounding factors, W measured using MRI was found to be associated with the disappearance of CSD (OR 1.134; 95% CI 1.050–1.224, P = 0.001). Subsequently, the W measured by MRI was selected in the prediction model, for which the C-index was 0.624. The area under the receiver operating characteristic curve in the least absolute shrinkage and selection model was 62.40% (95% CI 54.96–69.83%).

Conclusions

MRI and contrast-enhanced MRI were found to be relatively accurate methods for detecting CSD. Moreover, W measured using MRI was significantly associated with the disappearance of CSD after TVUDR.