Clinical Characteristics and Risk Factors of Coexisting Endometrial Lesions in Patients with Cesarean Scar Defect Undergoing Hysteroscopic Resection for Prolonged Menstruation

Objective: To investigate the clinical characteristics of patients with prolonged menstruation treated with hysteroscopic resection of a cesarean scar defect (CSD), and to analyze the high-risk factors for its coexistence with intrauterine pathologies, such as endometrial polyps or endometrial hyperplasia. Methods: This retrospective cohort study included 382 patients with prolonged menstruation who underwent CSD resection between January 2023 and December 2024. Based on the presence or absence of concurrent endometrial polyps or hyperplasia, the patients were divided into two groups: the simple CSD group (n=208) and the group with coexisting endometrial pathology (n=174). The definition of endometrial lesions was based on imaging and pathological examination findings, and all diagnoses were made by experienced physicians. Differences in demographics, clinical presentation, imaging parameters, and menstrual improvement were compared. Logistic regression was used to identify independent risk factors for endometrial lesions and develop a predictive model with a nomogram. Results: Compared with the simple CSD group, patients with coexisting endometrial disease had a higher rate of anemia (33.9% vs 17.3%, p