| Objective: To analyze the cases of intrauterine adhesions, and evaluate the outcome of pregnancy after hysteroscopic adhesiolysis and relevant factors of the outcome of pregnancy.Methods: A retrospective analysis is carried out to explore the clinical data of 171 cases of intrauterine adhesion patients who underwent hysteroscopic adhesiolysis in Fujian Provincial Maternal and Child Health Hospital from January 1,2011 to December 31,2012.The patients were divided into 4 groups depending the different ways that prevent reccurrence: Group A:none; Group B:Barrier; Group C: Artificial cycle; Group D: Barrier+Artificial cycle.And the pregnancy outcomes and symptoms by outpatient service or telephone were followed up.6 factors were analyzed by univariate and multivariate Logistic regression including :past history of preoperative Intrauterine operation, the times of hysteroscopic adhesiolys, postoperative menstrual pattern,severity of adhesions, recurrence and so on.Results:1. Intrauterine adhesions secondary to pregnancy-related intrauterine perations occurred in 72.5% of the patients,including 42.1% of curettage after natural abortion and 26.9% of induced abortion operation. The past history of preoperative intrauterine operation did not related to adhesions severity obviously(p>0.05).2. Severe patients with spanomenorrhea and amenorrhea were more than mild and moderate patients(p<0.05). The times of adhesions resection of severe patients were more than mild and moderate patients(p<0.05).There were significant diffenerce between Patients with different stages of intrauterine adhesions in the incidence of intrauterine re-adhesion(p<0.05).3.The recurrence rate of Severe patients was significantly higher than mild and moderate patients(p<0.05).The improvement rate of menses was lower than mild and moderate patients(p<0.05). Of the mild patients,the recurrence rate of Group D patients was lower than Group A, Group B, Group C(p>0.05),the improvement rate of menses was higher than the others(p<0.05). Of the moderate mild and severe patients, the recurrence rate of Group D patients was lower than Group B,C(p<0.05).4. Among the 171 patients,109 achieved pregnancy afer surgery. 78.0% achieved Pregnancy within postoperative 1 year, The rate of pregnancy decreased significantly with the time of interval from the time of surgery to the time of conce-ption increasing. 20% of the patients who had live birth had adherent placenta.The severer the adhesions, the more the placenta planting occurred(p<0.05).5. Of the patients with recurrence, improvement rate of menses, the pregnancy rate were,respectively,60.0%,40.0%. Of the patients without recurrence, improve-ment rate of menses, the pregnancy rate were,respectively,82.5%,70.8%.There were significant diffenerce between two groups. The pregnancy rate of the patients with improved Mense was 66.9%, which was significantly higher than those without improved Mense(p<0.05).6. Multivariate Logistic analysis of regression showed postoperative menstrual pattern and postoperative adhesion recurrence are dependent of Influential factors of the outcome of preganacy.Conclusion:1. The main aetiology of intrauterine adhesions is pregnancy-related intraute-rine operation. The main symptoms of intrauterine adhesions menstrual abnorma-lities, reproductive dysfunction. menstrual disorders depending on the degree of intrauterine adhesions.2. After TCRA,Many effective assisted ways can be used to prevent postopera-tive adhesion recurrence, to improve menstruation and pregnancy outcomes,and the effect of barrier + artificial cycle was better.3. Most of the patients acheved pregnancy within 1 year after surgery.Intraut-erine adhesions patients’ pregnancy that can lead to abnormal placenta planting was risk,which needs more careful nurse.4. After the treatment of Intrauterine adhesions, reducing the rate of postoperat-ive adhesion recurrence and improving the menstrual situation can effectively improving pregnancy outcome. |
