| Objective:1. To explore the relationship between the retained receptive endometrium and the severity of intrauterine adhesions or postoperative pregnancy outcomes.2.To investigate the relationship between the degree of injured uterine junctional zone of intrauterine adhesions (IUAs) by Magnetic resonance imaging (MRI) and the severity of IUA and pregnancy outcomes.Materials and Methods:We collected the clinical data of 160 patients who was conducted transcervical resection of adhesions (TCRA) in Department of Obstetrics & Gynecology, Chinese Navy General Hospital from February2012 to October 2015.According to the area of retained receptive endometrium of uterine cavity, IUAs were classified into three groups:Group A, the retained area of Receptive endometrium?1/2 of uterine cavity; Group B,1/4 to 1/2 of uterine cavity Receptive endometrium were retained; GroupC,?1/4 of uterine cavity receptive endometrium were retained or tubular cavity without any receptive endometrium retained.At the same time,92 IUAs conducted uterine MRI preoperative, according to whether uterine junctional zone (JZ) was injured or not, the patients were divided into two groups: Normal Groupwith 37 cases, JZ was normal and the boundaries of JZ was clear; Injured Group with 38 cases:JZ was partly or completely injured, the boundaries of JZ was unclear, or even JZ was unrecognizable.The officehysteroscopy was suggested the first month later.The severity of IUA and the reformation of adhesion were compared between groups. In February 2016,We telephoned all IUAs about their pregnancy outcomes,and pregnancy rate, live birth rate and pregnancy loss rate were compared.Results:1) Receptive endometrium and IUA:1. The general characteristics among the three groups:There were 72,34 and 54 cases in Group A,B and C, respectively. The difference of the patients'average age, follow-up time,number of pregnancy-related dilation and curettage (D&C) and the rate of recurrent spontaneous abortion(RSA) were not significant(P=0.059,0.241,0.757,0.065).The rate of infertility women in IUAs were 23.6%,26.5%and 57.4%,with significant differently(P= 0.0001).Varies auxiliary therapieswere given to prevent reformationof adhesions, including IUD, Foley catheter, COOK bladders, hormone therapy and other treatments, andthere were no statistically significant difference among the three groups (P=0.301,0.359,0.945,0.4,0.743).The rate of IVF-ET was not significantly different (P= 0.076).2. The degree of IUA among the three groups:According to European Society for Gynecological Endoscopy classification of IUA (ESGE), the number of mild, moderate and severe IUA in Group A were 27,41 and 4 cases respectively,5,22 and 7 in group B, and 3,7,44 cases in group C,respectively.The severe IUA rate of the three groups were 5.6%,20.6% and 81.5%,the difference was significant (P=0.0001)3. The outcomes among the three groups:The rate of adhesion reformation ofGroup A, B and C were 28.2%?66.7% and 78.9%,the pregnancy rate of were 69.7%, 51.6% and 29.8%, the difference was statistically significant(P=0.0001,0.015). The Menstruation improvement rate were75%.70.6% and 59.3%,the Live birth rate were 65.4%,50.0% and 42.9%,and the pregnancy loss rate were 17.3%,31.3% and 28.6%,which were not of statistical significant(P=0.163,0.234,P=0.403).2) JZ and IUA:1. The general characteristics among the two groups:There were no significant difference among the two groups in the average age, follow-up time,the number of previous D&C, the rate of infertility,and the rate of recurrent spontaneous abortion(RSA)(P=0.83?0.179.0.207.0.571?0.713).2. The degree of IUA among the two groups:According to ESGE classification, in Control Group, the number of mild, moderate and severe IUA was 8,23 and 6 respectively, and 5,11 and 22 in Injured Group. The severe IUA rate of the three groups were16.2% and 57.9%, and the difference was significant(P=0.0001).3. The outcomes of the two groups:The rate of adhesion reformation of the two groups were52.2% and 71.4%, and the menstruation improvement rate were 70.3% and 63.2%,both were not statistically significant (P=0.157,0.514).19 and 11 IUAs had been pregnant in control group and injured group respectively, and one of each group had been pregnant twice.The pregnancy rate in control group was higher than injured group,(51.4% VS 28.9%,P=0.048).The live birth rate of control group was higher than injured group, while the pregnancy loss rate was lower than that of injured group (45% VS 33.3%,P=0.713;30% VS 41.7%,P=0.703),,but the difference was not statistically significant.There were eight cases whose JZ was completely injured and JZ was unrecognizable.and all of them were diagnosed as grade V of ESGE, and no one had been pregnant.Conclusions1. IUA severity was closely correlated with the area of receptive endometrium, the less of receptive endometrium retained the more serious of IUA degree, and the poor pregnancy outcomes.2. Injured uterine junction zone decreased postoperative pregnancy rate and live birth rate, while raise pregnancy loss rate. When JZ was completely damaged, pregnancy outcomes were very poor.3. The retained area of receptive endometrium and injured degree of JZ may offer new perspectives to estimate severity of IUA and the pregnancy prognosis. |
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