Clinical effect analysis of comprehensive treatment for patients with moderate and severe intrauterine adhesions
10.3760/cma.j.cn101441-20200520-00296
- VernacularTitle:中重度宫腔粘连患者综合治疗的临床疗效分析
- Author:
Yali YE
1
;
Jihui AI
1
;
Yufeng LI
1
;
Lei JIN
1
;
Qiang LI
1
Author Information
1. 华中科技大学同济医学院附属同济医院生殖医学科，武汉430030
- Publication Type:Journal Article
- Keywords:
Intrauterine adhesions;
Treatment;
Pregnancy outcomes
- From:
Chinese Journal of Reproduction and Contraception
2022;42(2):170-176
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical effect and pregnancy outcome of infertile patients with moderate and severe intrauterine adhesions by comprehensive treatment.Methods:Totally 148 infertile patients with moderate to severe intrauterine adhesions who were hospitalized in the Department of Reproductive Medicine of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 1, 2017 to May 1, 2018 were retrospectively analyzed. They were divided into two groups based on American Fertility Association (AFS) scoring: the moderate group (79 patients) with an AFS score of 5-8 and the severe group (69 patients) with an AFS score of 9-12. All patients received comprehensive treatment for intrauterine adhesions, including intrauterine adhesion decompression and postoperative adjuvant therapy, such as estrogen, physical barrier and biogels. Through case investigation, telephone and outpatient follow-up, the postoperative review of uterine cavity, menstruation and pregnancy outcomes were collected, and the follow-up time was 24-36 months after surgery.Results:1) Postoperative recovery of uterine cavity: 80.41% (119 cases of 148) patients with intrauterine adhesions had improved uterine cavity environment, and 65 of 79 moderate patients had significantly improved uterine cavity environment, the improvement rate was 82.28% (65/79). The uterine environment was significantly improved in 54 cases of 69 severe patients, the improvement rate was 78.26% (54/69). 2) Changes of postoperative intrauterine AFS score: postoperative AFS score of patients with moderate intrauterine adhesions decreased (4.10±0.21) points, and the difference was statistically significant ( P<0.001). AFS score of patients with severe intrauterine adhesions decreased (7.12±0.30) points after operation, and the difference was statistically significant ( P<0.001). 3) Improvement of menstruation after surgery: in the first 3 months after surgery, 72 patients with moderate intrauterine adhesions (91.14%) had improved menstruation. A total of 57 patients (82.61%) with severe intrauterine adhesions had improved menstruation. Three months after surgery, 52 patients (65.82%) with moderate intrauterine adhesions had better menses than before; a total of 41 patients (59.42%) with severe intrauterine adhesions had improved menstruation. 4) Pregnancy outcome: among 79 patients with moderate intrauterine adhesions, 44 cases were pregnant, of which 37 cases delivered live births (19 cases of natural pregnancy, 18 cases of assisted reproductive pregnancy), with a live birth rate of 84.09%. There were 33 pregnancies and 20 live births (15 natural pregnancies and 5 assisted pregnancies) in the patients with severe intrauterine adhesions, with a live birth rate of 60.61%. Conclusion:The comprehensive treatment of intrauterine adhesions can obviously improve the uterine environment of moderate and severe intrauterine adhesions, reduce AFS score, improve menstruation, increase pregnancy rate and improve pregnancy outcome.
