Wei Hong, Zhiping Wu, Li Li, Beiying Wang, Xiaocui Li
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引用次数: 0
Abstract
Objective: To examine whether a history of hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies.
Design: Retrospective cohort study.
Setting: A tertiary-care hospital in Shanghai, China.
Population: A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021.
Methods: From the cohort of 114 142 pregnant women, each woman with a history of HA-treated IUA prior to the current pregnancy (n = 780) was matched with four women without a history of IUAs (n = 3010) using propensity score matching. The matching variables were maternal age and parity, mode of conception, pre-pregnancy body mass index and prior history of abortion.
Main outcome measures: Pregnancy complications, placental abnormalities, postpartum haemorrhage and adverse birth outcomes.
Results: Compared with women with no history of IUAs, women with a history of HA-treated IUAs were at higher risk of pre-eclampsia (RR 1.69, 95% CI 1.23-2.33), placenta accreta spectrum (RR 4.72, 95% CI 3.9-5.73), placenta praevia (RR 4.23, 95% CI 2.85-6.30), postpartum haemorrhage (RR 2.86, 95% CI 1.94-4.23), preterm premature rupture of membranes (RR 3.02, 95% CI 1.97-4.64) and iatrogenic preterm birth (RR 2.86, 95% CI 2.14-3.81). Those women were also more likely to receive cervical cerclage (RR 5.63, 95% CI 3.95-8.02) during pregnancy and haemostatic therapies after delivery (RR 2.17, 95% CI 1.75-2.69). Moreover, we observed that the RRs of those adverse obstetrical outcomes increased with the increasing number of hysteroscopic surgeries.
Conclusions: This study found that a history of HA-treated IUAs, especially a history of repeated HAs, was associated with an increased risk of adverse obstetrical outcomes.
目的：研究宫腔镜粘连溶解术（HA）治疗宫腔内粘连（IUAs）的病史是否与后续妊娠不良产科结局风险增加有关：研究宫腔镜粘连溶解术（HA）治疗宫腔粘连（IUAs）的病史是否与后续妊娠不良产科结局风险增加有关：设计：回顾性队列研究：背景：中国上海一家三级甲等医院：2016年1月至2021年10月期间，在上海市第一妇婴保健院获得产前卡并接受常规产前检查的114 142名孕妇组成的队列：在 114 142 名孕妇中，采用倾向得分匹配法，将每位在本次妊娠前曾接受过 HA 治疗的 IUA 孕妇（n = 780）与四位无 IUA 史的孕妇（n = 3010）进行配对。匹配变量为产妇年龄和奇偶数、受孕方式、孕前体重指数和既往流产史：妊娠并发症、胎盘异常、产后出血和不良分娩结局：与无 IUA 史的妇女相比，有 HA 治疗过 IUA 史的妇女发生先兆子痫（RR 1.69，95% CI 1.23-2.33）、胎盘早剥（RR 4.72，95% CI 3.9-5.73）、前置胎盘（RR 4.23，95% CI 2.85-6.30）、产后出血（RR 2.86，95% CI 1.94-4.23）、早产胎膜早破（RR 3.02，95% CI 1.97-4.64）和先天性早产（RR 2.86，95% CI 2.14-3.81）。这些妇女也更有可能在怀孕期间接受宫颈环扎术（RR 5.63，95% CI 3.95-8.02）和在分娩后接受止血疗法（RR 2.17，95% CI 1.75-2.69）。此外，我们还观察到，随着宫腔镜手术次数的增加，这些不良产科结果的RRs也随之增加：本研究发现，HA处理过的IUA史，尤其是重复HA史，与不良产科结局风险的增加有关。
期刊介绍：
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
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