Comparison of the Therapeutic Effects of VR and VR + GnRHa in the Treatment of Cesarean Scar Diverticula
Comparison of the Therapeutic Effects of VR and VR + GnRHa in the Treatment of Cesarean Scar Diverticula
Cesarean scar diverticula (CSD) is a novel recognized cause of postmenstrual abnormal uterine
 bleeding in women. No clinical guidelines have been issued for the management of CSD. The
 investigators have previously demonstrated that vaginal repair of CSD was an relative
 effective treatment of CSD. However, only 28.2% of the CSD patients normalized to less than 7
 days of menstruation, whereas 51.2% of women had 7 to 10 days of menstruation at 6 months
 post vaginal repair. Postoperative menstruation may contribute to surgical site infections,
 which may subsequently affect the healing of uterine scars. Treatment CSD patients with
 gonadotropin-releasing hormone agonist (GnRHa) may has the potential to improve therapeutic
 effects of vaginal repair. Therefore, the current multiple-center randomized controlled trial
 was designed to evaluate whether the application of GnRHa in combination with vaginal repair
 could achieve better clinical effects than those achieved by vaginal CSD repair alone.
Postoperative menstruation may contribute to surgical site infections, an inflammatory
 environment, congestion at the site of the suture, immune cell infiltration, and other
 effects and may subsequently affect the healing of uterine scars. It is reasonable to
 hypothesize that delaying the postoperative menstrual recovery period may allow uterine scars
 to heal without the inflammatory reaction caused by menstruation. Treatment with
 gonadotropin-releasing hormone agonist (GnRHa) has the ability to suppress
 follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release, thereby maintaining
 low estrogen levels and causing temporary amenorrhea. A prolonged menstrual recovery period
 may be achieved after GnRHa administration. Vaginal repair of CSD combined with GnRHa may
 improve the therapeutic effects of treatment of CSD. Therefore, the randomized study was
 designed to evaluate whether the application of GnRHa in combination with vaginal repair
 could achieve better clinical effects than those achieved by vaginal CSD repair alone.
Inclusion Criteria:

 1. Patients are younger than 40.

 2. Clearly diagnosed with CSD.

 3. Experiencing clinical features of abnormal uterine bleeding, prolonged menstrual flow
 (the duration of menstruation is more than 7 days).

 4. The thickness of the remaining muscular layer of CSD was less than 3 mm.

 5. The women are at least 20 years old with singleton pregnancies and had undergone a
 cesarean delivery after at least 37 weeks of gestation.

 6. The medicine conservative treatment is invalid.

 7. Refusing or use birth control pills contraindications.

 8. No serious medical problems (important viscera function in the normal range).

 9. No uterine fibroids, endometriosis, adenomyosis, and patients with ovarian cysts.

 10. No gynaecology or other malignant tumors.

 11. Sign the informed consent.

 Exclusion Criteria:

 1. Over the age of 40;

 2. Indefinite diagnosis.

 3. The absence of clinical manifestations of CSD.

 4. The presence of menstrual irregularities before cesarean delivery.

 5. Coagulation disorders.

 6. Malignant tumors.

 7. With severe medical problems (severe liver disease, kidney disease, respiratory
 diseases, heart disease or uncontrolled diabetes, epilepsy, etc., dysfunction of
 important organs).

 8. Known chronic inflammatory diseases, any other uterine diseases (such as uterine
 fibroids, endometriosis and adenomyosis), uterine surgery except cesarean section.

 9. Use of intrauterine devices.

 10. Unwilling to comply with the research plan.