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.