| Objective:Through the follow-up of pregnancy related conditions of patients with intrauterine adhesions after transcervical resection of adhesions,the relevant factors affecting the obstetric prognosis of patients were retrospectively analyzed,and the value of different scoring criteria for intrauterine adhesions at home and abroad in evaluating obstetric prognosis was compared,in order to provide certain clinical reference value for the management of patients with intrauterine adhesions.Methods:Patients who underwent transcervical resection of adhesions in the First Hospital of Shanxi Medical University from June 2018 to January 2021 were included in this study.Patients with fertility requirements were followed up until February 1,2022.And according to the intraoperative situation,according to the March classification,AFS(American Reproductive Society)classification,ESGE(European Society of Gynecological Endoscopy)classification(1998),Nasr classification and China classification.The data of all cases of patients who met the criteria were collected and sorted out,and the related factors affecting the obstetric prognosis of patients were analyzed retrospectively by statistical analysis,and the value of different classification criteria for intrauterine adhesions at home and abroad in evaluating obstetric prognosis was compared.Results:1.A total of 74 subjects were included in the study.Up to the final follow-up time,a total of 40 pregnancies,pregnancy rate was 54.05%;Six of them were still pregnant,and 34 of them had definite pregnancy outcomes.Among the patients with definite pregnancy outcome,1 case was ectopic pregnancy(2.94%),7 cases were early abortion(20.59%),6cases were late abortion(17.65%),5 cases were preterm birth(14.71%),15 cases were full term birth(44.12%),and the live birth rate was 58.82%.A total of 15 cases(44.18%)were complicated with obstetric complications,including placenta previa in 1 case,placental adhesion in 7 cases(4 cases with bleeding after abortion),placental implantation in 3 cases(1 case with bleeding after abortion),placental abruption in 1 case,placental abruption in 1case with placental implantation and placental residue in 2 cases.Among the patients with live birth,7 cases(35%)had vaginal delivery and 13 cases(65%)had cesarean delivery.There were 18 single fetuses(90%)and 2 twin fetuses(10%),both of which were premature.One of them underwent uterus curettage because of placenta residue.2.Intrauterine operation during pregnancy was the main cause of intrauterine adhesions(79.73%),and intrauterine operation in early pregnancy,including induced abortion and uterus curettage,was the main cause of intrauterine adhesions.(1)There were statistically significant differences between pregnant group and non-pregnant group in menstrual pattern(after surgery),adhesion region,adhesion properties and tubal opening(after surgery);However,there was no significant difference in age,number of pregnancies and deliveries,number of intrauterine operations,number of abortions,menstrual pattern(before operation),adhesion etiology,adhesion duration,tubal opening(before operation),anti-adhesion measures and number of separations of adhesions.(2)AFS classification was significantly correlated with pregnancy rate,and the pregnancy rate of patients classified as severe was significantly lower than that of mild and moderate patients;The other four classification criteria had no significant correlation with pregnancy rate.Logistic regression analysis showed that for each unit increase in AFS score,the likelihood of a patient being identified as pregnant became 0.357 times higher,that is,the higher AFS score,the lower the probability of pregnancy.ROC curve was drawn to evaluate the predictive value of AFS classification on pregnancy rate.The results showed that AUC value was 0.642,specificity was 0.559,and sensitivity was 0.725,indicating that the predictive effect of the model was good.3.(1)There were no statistically significant differences between the live birth group and the non-live birth group in age,pregnancy times,intrauterine operation times,abortion times,menstrual pattern(postoperative),adhesions cause,adhesions duration,adhesions region,adhesions properties,adhesions prevention measures,adhesions separation times,pregnancy mode and the time between pregnancy and the last operation.(2)There was no significant correlation between the five classification criteria and live birth.4.There were statistically significant differences in the number of pregnancies and adhesion region between the abnormal placenta group and the non-abnormal placenta group.However,there was no significant difference in age,number of deliveries,number of intrauterine operations,number of abortions,properties of adhesions,number of separations of adhesions,mode of pregnancy,and time between pregnancy and last operation.Conclusion:1.For patients with intrauterine adhesions,transcervical resection of adhesions can effectively improve the pregnancy rate,intraoperative attention should be paid to the nature and location of adhesions,in order to restore the intrauterine morphology,effective protection of endometrium.Comprehensive treatment was given according to the condition of the patients after surgery.Improvement of menstruation was an important observation index,and early hysteroscopy was performed to guide pregnancy in time.One year after surgery may be the best period of pregnancy.However,IUA patients have a high rate of postpregnancy abortion,while the risk of obstetric complications such as placental abnormalities and post-abortion bleeding is significantly increased,resulting in a poor overall live birth rate.Therefore,individualized management should be adopted for such high-risk pregnant women,especially strengthening placental monitoring during pregnancy,so as to detect placental abnormalities as soon as possible,keep alert of prenatal and postpartum bleeding,and effectively improve the prognosis of mothers and children.2.Since different classification criteria incorporate different factors,scoring or rating the same patients with different classification criteria will not yield the same results,that is,differences in the severity of adhesions obtained.This study recommends the use of the AFS classification,which may be a better match for postoperative pregnancy in patients with IUA;however,none of the five classifications is significant in assessing live birth.Therefore,there is still a need to explore a more reasonable classification that incorporates a more comprehensive range of factors to improve the predictive value of the prognosis in obstetrics. |
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