Retrospective Analysis of Prognostic Factors and Pregnancy Outcomes in Patients with Moderate-to-Severe Intrauterine Adhesions Following Hysteroscopic Adhesiolysis and Modified Intrauterine Stent Intervention.

Abstract

Objective: To assess the clinical prognosis and reproductive outcomes in individuals presenting with moderate-to-severe intrauterine adhesion (IUA) following the administration of hysteroscopic adhesiolysis (HA) in conjunction with modified intrauterine stents.

Methods: A cohort comprising 156 individuals diagnosed with IUA (105 with moderate severity and 51 with severe severity) was enrolled. Subsequent to hysteroscopic intervention, all participants received intrauterine stent placement during the immediate postoperative phase. A comprehensive follow-up period of 2 years post-stent removal was instituted.

Results: The occurrence of adhesion recurrence increased progressively, demonstrating a recurrence rate of 11.54% at hysteroscopic reevaluation administrated in 3 months after surgery and surging to 32.69% during the 2-year follow-up period. Comparative analysis indicated a statistically significant reduction in recurrence rates among patients with moderate IUA compared to severe IUA (P < 0.05). The median duration of stent placement was determined to be 4 months. Postoperatively, patients exhibited a cumulative pregnancy rate of 71.79%, with a live birth rate of 79.28%. Significantly, patients with moderate IUA exhibited a significantly elevated pregnancy rate in comparison to those with severe IUA (P = 0.004). Multifactorial logistic regression analysis revealed that the severity of IUA was an independent risk factor for recurrence risk. Furthermore, the severity of IUA and postoperative re-adhesion emerged as contributory factors to the infertility observed in these patients.

Conclusion: The combination of HA with a modified intrauterine stent demonstrates efficacy in the treatment of IUA; however, outcomes remain suboptimal for cases characterized by severity. The prognostic assessment of patients and the suggested criteria for the removal of intrauterine stents, as delineated in the study, are considered both feasible and recommendable for clinical practice. Furthermore, conscientious and attentive management is imperative for the mitigation of adverse pregnancy such as early pregnancy loss in individuals afflicted with IUA during pregnancy.