关键词: 组织黏连, 宫腔镜, 妊娠率, 回归分析

Abstract: Objective：To investigate the pregnancy outcomes and its related influencing factors of moderate and severe intrauterine adhesions after transcervical resection of intrauterine adhesions(TCRA). Methods: One hundred and forty-five patients with moderate-to-severe IUA (IUA score ≥5) with fertility dysfunction who were diagnosed at the Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2014 to December 2016 were selected. The pregnancy outcome after TCRA was followed-up and the factors that may affect pregnancy were analyzed. Results: ①Among 145 patients with moderate to severe IUA, the pregnancy rate after TCRA was 46.9% (68/145), the natural conception rate was 54.4% (37/68), and artificial assisted conception rate was 45.6%(31/68); The pregnancy rate of secondary infertility was 45.8%(33/72), that of the adverse pregnancy history and the primary infertility was 48.3%(28/58), 46.7%(7/15) respectively. The postoperative pregnancy rate in patients with moderate IUA and severe IUA were 64.9% (48/74) and 28.2% (20/71), respectively. The pregnancy rate of patients with pregnancy-related curettage ≥ 3 times was 36.6%(34/93), while the others was 65.4% (34/52). The pregnancy rates of patients with normal menstruation, menstruation reduction and amenorrhea preoperatively were 73.1%（19/26）, 48.8% (40/82) and 24.3%(9/37), respectively. The pregnancy rate of of patients with normal menstruation, menstruation reduction postoperatively was 54.6% (59/108) and 28.6% (8/28) respectively. Among 28 patients with re-adhesion, only two patients with mild adhesions were pregnant (7.1%, 2/28). 41.2% (28/68) of pregnancies had abortion or spontaneous abortion before 12 weeks of gestation and 58.8% (40/68) were reached to live births, with the mean gestational age of 38±1 weeks (32 to 41 weeks), and mean body weight of 3 467± 461 g (1 800 to 4 400 g). For obstetric complications, there were 2 cases of placenta previa, 6 cases of postpartum hemorrhage, and 2 cases of blood transfusion. No uterine rupture occurred. ②Multivariate logistic regression was performed by stepwise regression.Only pregnancy-related curettage, preoperative adhesion, and postoperative re-adhesion were found to be independent predictors of postoperative pregnancy outcomes (P＜0.05). Conclusions: Even after TCRA surgery to restore uterine cavity morphology, the pregnancy rate of moderate to severe IUA is still low, especially the patients with recurrence of IUA. So pay attention to the protection of residual endometrium during surgery, and take effective measures to promote endometrium regeneration and prevention of re-adhesion after surgery are the key to treatment.

Key words: Tissue adhesions, Hysteroscopes, Pregnancy rate, Regression Analysis