Hubungan Faktor Risiko Antepartum, Intrapartum dan Postpartum dengan Kejadian Defek Luka Sesar / Niche Setelah Operasi Sesar

Abstract

Background: Cesarean scar defect niche is a complication of a cesarean section that has long-term implications for both obstetrics and gynecology. The rate of niche is believed increasing with the high number of cesarean sections. This study's objective is to assess the risk factors for niche development after cesarean section Methods: A prospective cohort study was conducted on women who underwent cesarean section at the Haji Adam Malik General Hospital between August 2021 and August 2022. Niche was assessed 6 weeks after cesarean section using transvaginal ultrasonography. The main outcome was the presence of niche. The antepartum, intrapartum dan postpartum risk factors were analyzed to niche development. A logistic regression model was used to assess independent risk factors from bivariate analysis Results: There were 70 patients enrolled in this study. The prevalence of niche was 44.3% by using transvaginal ultrasound. There was no significant relationship between maternal age, gestational age, parity, nutritional status based on UAC, hypertension in pregnancy, anemia status, surgical indications, locking or nonlocking uterine closure, duration of surgery and volume blood loss and puerperal infection to niche development (P > 0.05). The independent risk factors for niche development were Cervical dilatation > 4 cm (P = 0.035; RR: 1.75), locking suture technique (P = 0.015; RR = 13.81), non-closure vesicouterine folds (P = 0.04; RR = 0.14) and a retroflexed uterus (P = 0.001; RR: 0.039). Conclusion: Cervical dilatation > 4 cm, locking suture technique, non-closure vesicouterine folds, and a retroflexed uterus are risk factors for cesaeran scar defect / niche development after CS