The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study

Abstract

Abstract Introduction The aim of this study was to explore the prevalence and predictors of cesarean scar defect ( CSD ) at 6 weeks postpartum in Shanghai, China. Material and methods Women scheduled to receive a cesarean section (CS) were recruited from a university hospital. Surgery‐related factors, pregnancy complications, routine examinations, perioperative medications, and physical signs were collected and transvaginal ultrasonography was performed to assess the presence of a CSD at 6 weeks postpartum. Multivariate logistic regression was applied to identify the predictors for CSD . Results A CSD was detected in 223 of 514 women (43.4%, 95% CI 39.1%‐47.7%) by transvaginal ultrasonography. Of women with normal temperature ( T < 37.5°C, CSD prevalence 33.9%, 95% CI 28.4%‐39.5%), women with postpartum fever ( T ≥ 38°C, CSD 44.1%, 95% CI 31.0%‐57.1%), and women who were subfebrile in the postpartum (37.5 ≤ T ≤ 38.0°C, CSD 58.3%, 95% CI 50.9%‐65.7%), the latter two had significantly increased risk for CSD (adjusted odds ratio [ aOR ] 2.7, 95% CI 1.3‐5.2 and aOR 3.3, 95% CI 2.1‐5.3, respectively). In comparison to single‐dose antibiotic administration ( CSD 49.0%, 95% CI 43.8%‐54.3%), multi‐dose antibiotic administration ( CSD 31.1%, 95% CI 23.8%‐38.3%) had a protective effect ( aOR 0.4, 95% CI 0.3‐0.7). Postpartum fever, intrapartum infection, emergency CS , and cervical dilation ≥ 3 cm were found to be the main predictors of multi‐dose antibiotics management. Low platelet count postpartum (defined as ≤ 150 × 10 9 /L) and high fibrinogen pre‐ CS (defined as ≥ 4.5 g/L) increased CSD risk ( aOR 2.0, 95% CI 1.1‐3.6 and 1.7, 95% CI 1.1‐2.5, respectively). Conclusions The prevalence of CSD in the Chinese population is high enough to be a concern. Perioperative infection and hypercoagulability should be considered CSD predictors, and multi‐dose antibiotics have a protective effect.