A prediction model for the efficacy of transvaginal repair in patients
with cesarean scar diverticulum: An evidence-based proposal for patient
Objective: To establish a prediction model to help the doctor
determine which patients are more suitable for transvaginal repair based
on the prediction model. Design:All enrolled patients underwent
CSD repair performed by a single team. All women in this study had a
follow-up clinic visit at 6 months to record their menstruation and
measure multiple parameters of the CSD by MRI.
Setting:Retrospective study Sample: This study
included 1015 women who underwent transvaginal repair of cesarean scar
diverticulum (CSD) at Xinhua Hospital and Shanghai First Maternity &
Infant Hospital between June 2014 and May 2021. Main outcome
measures: CSD patients are categorized as having optimal healing when
the menstruation duration is no more than 7 days and the thickness of
residual myometrium（TRM） is no less than 5.39 mm after vaginal repair.
The final nomogram is constructed to predict surgical outcomes based on
pre- and postoperative variables. Results: The key factors
determining optimal healing are the timing of cesarean section;
menstrual cycle; CSD length, width, depth, and the myometrial layer
thickness of the lower uterine segment. With the prediction model,
scores are given to each parameter according to the statistics. Total
scores range from 0 to 25 points with a cutoff point of 16.5. Predicted
that transvaginal repair achieves optimal healing when a score greater
than 16.5 points. Uterine position and preoperative TRM are the key
factors affecting postoperative TRM. The width of the CSD and the
thickness of the lower uterine segment are the key factors affecting
postmenstrual abnormal uterine bleeding (P<0.01).
Conclusions: We establish a prediction model system for the
first time that may predict the repair effect of CSD and can potentially
be useful in future clinical trials to determine which patients should
be repaired or other treatment options.