Patients and methods
This retrospective study was approved by the ethics committee of the Shanghai First Maternity & Infant Hospital (KS1512). We retrieved data of 331 outpatients with CSDs who underwent MRI to determine the length, width, and depth of the defect and subsequent vaginal surgery at the Tongji University-affiliated Shanghai First Maternity & Infant Hospital from January 2013 to August 2017. All MRI scans were re-evaluated by an experienced radiologist. After educating patients on the advantages and disadvantages of vaginal surgery, patients provided written informed consent. According to the findings of preoperative MRI scans, patients were divided into two groups, the adenomyosis group (group A) and the non-adenomyosis group (group B).
The inclusion criteria were patients who had one or more cesarean deliveries, patients who had intermenstrual spotting after the cesarean section or those in which the TRM was less than 3.0 mm at the preoperative stage, and patients who underwent MRI and TVS to evaluate the size of the defect and the TRM before surgery (Fig. S1). Patients who had a history of endocrine disorders, menstrual irregularities before cesarean section, coagulation disorders, use of intrauterine devices, sub-mucous myoma, endometrial diseases, endometrial cysts, uterine fibroids, and adenomyosis after cesarean section were excluded from this study.