反复妊娠流产和宫腔粘连患者宫腔镜粘连溶解术后的生殖效果。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-01-01 DOI:10.1016/j.jmig.2024.09.009

Xinyu Qiao MD , Dong Liu MD , Chang Liu MD , Tianjiao Pei MD, PhD , Yunwei Ouyang MD, PhD

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引用次数: 0

摘要

目的本研究旨在评估复发性妊娠丢失（RPL）合并宫腔内粘连（IUA）患者宫腔镜粘连溶解术后的生殖结局.设计单中心回顾性队列研究.患者在2018年1月至2022年6月期间，对64名被诊断为RPL和IUA的女性进行了研究，宫腔镜粘连溶解术后随访至少一年。主要测量指标宫腔镜粘连溶解术后的活产率和月经模式变化（主观评估）。结果在我们的队列中，59.38%（38/64）的患者在宫腔镜粘连溶解术后怀孕，92.11%（35/38）的患者在术后两年内受孕。流产率为 17.19%（11/64），活产率为 42.19%（27/64）。在延长的随访期内，64.06%（41/64）的患者表示宫腔镜粘连分解术后经血量增加，月经模式也有所改善。单变量分析表明，年龄≥35 岁（P=.026）、有不孕史（P=.003）、存在中度或重度 IUA（P=.023）以及手术后月经改善（P=.001）是活产的独立预测因素。多变量分析进一步确定，有不孕史的妇女在宫腔镜粘连溶解术后活产的几率降低（P=.008），而术后月经改善的妇女活产的几率增加（P=.031）。结论我们的研究结果表明，RPL和IUA患者既往无不孕史，且在宫腔镜粘连溶解术后月经改善，更有可能获得活产。标准化的宫腔镜治疗、术后防粘连护理和早期妊娠计划是改善这些患者生育结果的关键。

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Reproductive Outcomes After Hysteroscopic Adhesiolysis in Patients Experiencing Recurrent Pregnancy Loss and Intrauterine Adhesions

Objective

This study aims to evaluate the reproductive outcomes after hysteroscopic adhesiolysis in patients experiencing recurrent pregnancy loss (RPL) combined with intrauterine adhesions (IUA).

Design

Single-center retrospective cohort study.

Setting

International referral hospital for women with IUA and RPL.

Patients

Between January 2018 and June 2022, a cohort of 64 women diagnosed with RPL and IUA were studied, with a follow-up period of at least one year after hysteroscopic adhesiolysis.

Interventions

All patients had a diagnosis of IUA from the diagnostic hysteroscopy and were treated with hysteroscopic adhesiolysis, utilizing intraoperative ultrasound monitoring as required.

Main Measurements

Live birth rate and menstrual pattern change (subjective assessment) after hysteroscopic adhesiolysis.

Results

In our cohort, 59.38% (38/64) achieved pregnancy following hysteroscopic adhesiolysis, with 92.11% (35/38) conceiving within two years of the procedure. The miscarriage rate was recorded at 17.19% (11/64), and the live birth rate stood at 42.19% (27/64). Throughout the extended follow-up period, 64.06% (41/64) of the patients reported increased menstrual blood volume and improvements in menstrual patterns posthysteroscopic adhesiolysis. Univariate analysis indicated that being aged ≥35 years (p = .026), having a history of infertility (p = .003), the presence of moderate or severe IUA (p = .023), and experiencing menstrual improvements postsurgery (p = .001) were independent predictors of live birth. Multivariate analysis further identified that women with a history of infertility had a reduced chance of live birth following hysteroscopic adhesiolysis (p = .008), while those who reported menstrual pattern improvements postoperatively had an increased probability of achieving a live birth (p = .031).

Conclusions

Our findings indicate that RPL and IUA patients without prior infertility and showing menstrual pattern improvement after hysteroscopic adhesiolysis, are more likely to achieve live births. Standardized hysteroscopic treatment, postoperative anti-adhesion care, and early pregnancy planning are key to improving fertility outcomes in these patients.

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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.