The Adverse Impact of Endometrial Trauma on Pregnancy Outcomes; A Real-World Evidence Study

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2024-11-01 DOI:10.1016/j.jmig.2024.09.098

MG Munro , C Martin , IB Feldberg , O Kshirsagar , D Sobti , MP Bharadwaz , J Miller , R Wang

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Abstract

Study Objective

Evaluate pregnancy outcomes in women following uterine surgery, including hysteroscopic adhesiolysis.

Design

Retrospective study.

Setting

Database.

Patients or Participants

A 6.5-year United States 150-payor database comprising 120 million patients with commercial, Medicaid, or Medicare coverage.

Interventions

Pregnancy outcomes in women with hysteroscopic adhesiolysis, uterine surgery without adhesiolysis, or no documented uterine surgery.

Measurements and Main Results

The database was searched for individuals with continuous enrollment, identifying three cohorts with trailing data back to April 2017: A history of intrauterine adhesiolysis (HA), a uterine procedure, but no adhesiolysis (UP), and those without any history of uterine surgery (NoUP). All cohorts were followed until May 2023 (41 months) to identify those with a completed pregnancy. Propensity score matching was employed to make the baseline cohort composition similar. Preterm delivery, placenta accreta spectrum, placenta previa, and postpartum hemorrhage were all identified more frequently in those undergoing previous surgery as follows: Preterm Delivery: HA - 14.5%, UP - 10.1%, NoUP - 8.4%, p <0.05. Placenta Accreta Spectrum: HA - 4.6%, UP – 0.9%, NoUP – 0%, p <0.05. Placenta Previa: HA - 13.5%, UP - 10.1%, NoUP – 3.9%, p < 0.05. Postpartum Hemorrhage HA – 17.7%, UP – 25%, NoUP – 7.8% p < 0.05.

Conclusion

In this study, women identified with a history of hysteroscopic adhesiolysis experienced increased risks of preterm delivery, placenta accreta spectrum, placenta previa, and postpartum hemorrhage compared to those without a history of uterine surgery in the study interval. While the magnitude of the difference was less, those with uterine surgery absent adhesiolysis were also at increased risk. These data align with findings from other cohort studies and suggest that endometrial trauma is a risk factor for adverse pregnancy outcomes for both the women and the fetus, likely incurring the expenditure of considerable healthcare resources. Research and development of means by which such trauma could be minimized is needed.

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子宫内膜创伤对妊娠结局的不利影响；一项真实世界证据研究

研究目的评估子宫手术（包括宫腔镜粘连松解术）后妇女的妊娠结局.设计回顾性研究.设置数据库.患者或参与者6.5年的美国150家支付方数据库，包括1.2亿名商业、医疗补助或医疗保险患者。干预措施宫腔镜粘连溶解术、未进行粘连溶解术的子宫手术或未记录子宫手术的女性的妊娠结局.测量和主要结果对数据库中连续注册的个人进行搜索，确定了三个队列，其追踪数据可追溯至2017年4月：有宫腔内粘连溶解史（HA）、有子宫手术但无粘连溶解史（UP）和无任何子宫手术史（NoUP）。对所有组群进行随访，直至 2023 年 5 月（41 个月），以确定完成妊娠者。为了使基线队列组成相似，采用了倾向得分匹配法。早产、胎盘早剥、前置胎盘和产后出血在接受过手术的孕妇中发生率较高，具体情况如下：早产：HA - 14.5%，UP - 10.1%，NoUP - 8.4%，P <0.05。前置胎盘：HA - 4.6%，UP - 0.9%，NoUP - 0%，P <0.05。前置胎盘HA - 13.5%，UP - 10.1%，NoUP - 3.9%，P <0.05。产后出血 HA - 17.7%，UP - 25%，NoUP - 7.8% p <0.05.结论在这项研究中，与在研究区间内没有子宫手术史的妇女相比，有宫腔镜粘连溶解史的妇女发生早产、胎盘早剥谱系、前置胎盘和产后出血的风险更高。虽然差异的程度较小，但那些接受过子宫手术但没有进行过粘连分解术的产妇的风险也会增加。这些数据与其他队列研究的结果一致，表明子宫内膜创伤是导致妇女和胎儿不良妊娠结局的风险因素，很可能会耗费大量的医疗资源。有必要研究和开发可最大限度减少这种创伤的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.