| BackgroundIntrauterine adhesion (IUA) refers to a consequence of trauma to the the basal layer of the endometrium caused by any factor, producing partial or complete obliteration in the uterine cavity, resulting in conditions such as menstrual abnormalities, infertility, or recurrent pregnancy loss. It has been more than a century since Heinrich Fritsch first described it. In recent years, the incidence rate showed an upward trend. Because it caused the serious influence on the women’s reproductive health, clinicians has been paid more attention to it. At present, there are also many relevant research and literature about it in domestic and international, they discovered a lot of the potential risk factors, but the exact cause of it is unclear. The related researches agree that curettage operation associated with pregnancy are the main factors leading to intrauterine adhesions. In recent, the main treatment for intrauterine adhesions is hysteroscopic adhesiolysis, Although the use of adjuvant therapy for prevention of adhesion recurrence after operation, the prognosis is still poor, and the recurrence rate is high. According to the reports, postoperative recurrence rate of intrauterine adhesions is3.1%-23.5%, recurrence of the severe adhesion even as high as20%-62.5%. Therefore, to prevent the occurrence of adhesion is more important. In recent years, both Domestic and abroad have many reports related to the mechanism、diagnosis and treatment、therapeutic effect and prognosis of intrauterine adhesions. However, there are have less research on the related risk factors of intrauterine adhesions. Therefore, we need to study the possible risk factors of it in further, to provide the basis for how to reduce the occurrence of intrauterine adhesions.ObjectiveTo explore the effect of the related factors of uterine cavity operation on intrauterine adhesions and to found the risk factors associated with it by clinical control study. To offer reliable clinical evidence for how to reduce and avoid the occurrence of intrauterine adhesions.MethodsCollecting188women with intrauterine adhesions and188non-intrauterine adhesions in the affiliated obstetrics and Gynecology Hospital of Zhejiang University School of medicine from December.2012to December.2014. In retrospective study, analysis the general characteristics of all the cases in two groups(including age, occupation, education level), past family (including the term delivery, preterm delivery, induced labour in mid-pregnancy, times of medical abortion、curettage、missed abortion、inevitable abortion), condition of the last pregnancy(normal pregnancy, missed abortion, incomplete abortion, inevitable abortion, hydatidiform mole), whether the use of tocolytic drugs, whether the last operation is painless, the interval time between last pregnancy and the previous pregnancy, termination of pregnancy is success or not, the situation of Postoperative bleeding and infection, the use of contraception measures after operation, compare the difference of two groups.Results1.Compare of the general characteristics:The average age of the two groups were31+6.40years、33+5.00years, there was no statistical difference between the two groups(P>0.05),Occupation and education level were no statistically significant between the two groups (P>0.05).2. Compare of the past family:In Study group and control group, the number of the cases with the history of term delivery were55and116respectively, there was significant difference between the two groups. The number of the cases with the history of preterm delivery were10and1respectively, there was significant difference between the two groups. The number of the cases with the history of induced labour in mid-pregnancy were21and5respectively, there was statistical difference between the two groups. The number of the cases with the history of medical abortion were27(once)、5(twice)、3(three times),10(once)、1(twice、0(three times), there was statistical difference in total between the two groups. The number of the cases with the history of curettage were43(once)、61(twice)、45(three times)、18(four times)、21(five times and more),100(once)、57(twice)、21(three times)、9(four times)、1(five times and more) respectively, there was Statistically significant differences in total between the two groups. The number of the cases with the history of missed abortion were57(once)、13(twice)、5(three times)、26(once)、7(twice)、1(three times) respectively, there was Statistically significant differences in total between the two groups. The number of the cases with the history of inevitable abortion were22(once)、1(twice)、1例(three times and more),12(once)、1(twice)、0(three times and more) respectively, there was no statistical difference in total between the two groups. 3. Compared of the related factors of the last cavity operation:In Study group and control group, the number of normal pregnancy were85and145respectively, there was Statistically significant differences between the two groups. The number of missed abortion were75and30respectively, there was Statistically significant differences between the two groups. The number of incomplete abortion were8and2respectively, there was no statistical difference between the two groups. The number of inevitable abortion were17and11respectively, there was no statistical difference between the two groups. The number of hydatidiform mole were3and0respectively, there was no statistical difference between the two groups. The interval time between last pregnancy and the previous pregnancy was in3months, the number were2and0respectively; with3to6months, the number were18and5respectively; with6to12months, the number are27and24respectively; with1to2years, the number were42and32respectively; with more than2years, the number were53and66respectively; the number of first pregnancy were35and43respectively; there are respectively11and18cases whom interval time is unknown, there was no statistical difference in total between the two groups. The number of tocolysis with traditional Chinese medicine were6and1respectively; there was no statistical difference between the two groups. The number of tocolysis with progesterone drugs were56and20respectively; there was statistical difference between the two groups. The number of painless operation were105and84respectively; there was statistical difference between the two groups. There were respectively48cases and4cases whose termination of last pregnancy was not success, there was statistical difference between the two groups. The time of postoperative bleeding was more than2weeks, there were7and0respectively, there was statistical difference between the two groups. The number with the symptoms of infection after operation were3and1respectively, there was no statistical difference between the two groups. The number of use of condom after operation were114and138respectively, there was statistical difference between the two groups. The number of use of contraceptive were3and1respectively, there was no statistical difference between the two groups. The number of use of contraceptive were intrauterine device are3and10respectively, there was statistical difference between the two groups. The number of use of emergency contraception were2and2, there was no difference. The number of use of other contraceptive methods or no contraception were42and37respectively, there was no statistical difference between the two groups. There were24cases with Asexual or contraception situation is unknown in study group.4.The results of multivariate analysis:significant indicator with univariate analysis were concluding:the history of term delivery, preterm delivery, induced labour in mid-pregnancy, the times of medical abortion, curettage、missed abortion, the last pregnancy was missed abortion, tocolysis with progesterone drugs, painless operation, termination of last pregnancy was not success, the time of postoperative bleeding was more than2weeks, use of condom and intrauterine device after operation. Multivariate analysis showed that, the history of term pregnancy was correlated with intrauterine adhesion negatively, but the times of missed abortion and curettage, tocolysis with progesterone drugs and painless operation were correlated with intrauterine adhesion positively.ConclusionThe more curettage and missed abortion, the greater risk of intrauterine adhesion, tocolysis with progesterone drugs and painless operation were also increased the risk of intrauterine adhesions. But, the history of term pregnancy can reduce the risk of intrauterine adhesions, it is that the risk of intrauterine adhesions is greater after curettage in nullipara. |
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