| ObjectiveBased on detailed clinical case data,this study explored the related risk factors of severe intrauterine adhesions,aiming to provide references for clinical optimization of the prevention and treatment strategies of severe intrauterine adhesions and improve the health of women of childbearing age.MethodsThis study adopts a case-control study design,strictly in accordance with the inclusion and exclusion criteria;A total of 576 patients who were admitted to the Northwest Women’s and Children’s Hospital for hysteroscopic surgery due to intrauterine adhesions from January 2018 to January 2020 were selected as the research objects.Refer to the scoring standard of the American Fertility Society(AFS)for intrauterine adhesions,Set the 254 patients with severe intrauterine adhesions with an AFS score greater than or equal to 9 points as the severe group(case group),the 322 patients with mild to moderate intrauterine adhesions with an AFS score less than 9were set as the mild to moderate group(control group).Collected relevant research variables,such as :the general demographic characteristics of patients(Age,education level,occupation,height,weight,living area and nationality);Medical history data of pregnancy-related invasive operations such as abortion and uterine purging(Number of induced abortions,number of medical abortions,number of missed abortions and evacuation,number of residual evacuation of uterine cavity,number of hydatidiform moles,number of manual removal of the placenta,total number of evacuation);Past birth history,history of uterine interventional surgery and related medical history of pelvic inflammatory diseases(Pregnancy,parity,full-term normal delivery,cesarean delivery,induction of labor,uterine artery embolization,diagnostic curettage,history of pelvic inflammatory disease,history of genital tuberculosis);Medical history data related to previous hysteroscopic resection operations(The number of hysteroscopic endometrial polyp resections,submucosal myoma resections,uterine mediastinum resections,uterine adhesions resections,scar pregnancy resections,and other hysteroscopic surgery history data and uterine cavity Total number of operations).Introduce the relevant variables into the Logistic regression model for univariate analysis,Single factors with statistical differences are included in the multivariate Logistic regression model for multivariate analysis,Then discuss the related risk factors of severe intrauterine adhesions.Result1.There was no statistically significant difference in general demographic data(age,education level,occupation,height,weight,living area and ethnicity)between the two groups.2.After univariate logistic regression analysis,The results show that increase in the number of pregnancy times(OR=1.36,95%CI=1.11-1.39,P=0.010),the number of induced abortions(OR=1.36,95%CI=1.18-1.56,P<0.001),the number of missed abortions(OR=2.01,95%CI=1.38-2.95,P=0.002),the total number of uterine evacuation(OR=1.26,95%CI=1.06-1.49,P=0.007),the number of submucosal myoma resections(OR=1.79,95%CI=1.60-2.22,P=0.005)and the total number of uterine cavity operations(OR=1.56,95%CI=1.35-1.81,P=0.001)increases the risk of severe IUA;The number of full-term normal births(OR=0.21,95%CI=0.16-1.71,P=0.001)increased and the risk of severe IUA decreased.3.Incorporate variables with statistical differences in univariate analysis into a multivariate Logistic regression model for multivariate Logistic analysis,The results show that increase in the number induced abortions(OR=2.44,95%CI=1.49-2.11,P<0.001),missed abortions(OR=2.23,95%CI=1.18-2.65,P=0.003),total number of uterine cleanings(OR=2.27,95%CI=1.37-2.71,P=0.001),total number of uterine cavity operations(OR=1.37,95%CI=1.26-1.89,P=0.037)increases the risk of severe IUA;The number of full-term normal births(OR=0.38,95%CI=0.18-0.57,P=0.002)increased,and the risk of severe IUA was reduced.4.After stratified analysis according to age,the results are consistent with the results of non-stratified analysis;after stratified analysis according to education level,the results are consistent with the results of non-stratified analysis.Conclusions1.The number of induced abortions,the number of missed abortions,the total number of uterine cleanings,and the total number of uterine cavity operations are risk factors for severe IUA;The greater the number of induced abortions,missed abortions,total number of uterine eliminations,and total number of uterine cavity operations,the higher the risk of severe IUA.2.The number of full-term vaginal births increases,and the risk of severe IUA is reduced;women are warned to avoid invasive surgical operations in the uterine cavity caused by unintended pregnancy before giving birth.3.In clinical work,it is necessary to avoid artificial abortion and missed abortion and uterine cavity invasive surgical operations as much as possible;It is necessary to promote contraceptive knowledge,improve contraceptive awareness,correct the contraceptive concept of people who have not given birth,and guide the masses of people to implement efficient contraceptive measures,Reducing the harm caused by invasive uterine cavity operations such as induced abortion caused by unintended pregnancy from the source is an important link in reducing the incidence of severe IUA. |
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