Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
Fertil Steril. 2015 Mar;103(3):775-9. doi: 10.1016/j.fertnstert.2014.11.016. Epub 2014 Dec 17.
To assess the prevalence and risk factors for intrauterine adhesions (IUAs) after hysteroscopic treatment of retained products of conception (RPOC).
Retrospective cohort study.
Gynecologic endoscopy unit.
PATIENT(S): A total of 167 women referred to our institution from 2009 to 2013.
INTERVENTION(S): Operative hysteroscopy for treatment of RPOC and office hysteroscopic follow-up to assess for IUA.
MAIN OUTCOME MEASURE(S): We investigated demographic characteristics, obstetrics parameters, and surgical variables to evaluate which factors could be associated with IUA formation.
RESULT(S): Of 167 women treated for RPOC, 84 (50.3%) had undergone a follow-up hysteroscopic evaluation after the operative hysteroscopy and were included in the study. Intrauterine adhesions were found in 16 cases (19.0%), of which only 3 (3.6%) were severe adhesions. Multivariate analysis showed that the presence of IUA was associated with RPOC after cesarean section (5 of 10 [50.5%] developed IUA, vs. 7 of 49 [14.3%] after vaginal delivery). Intrauterine adhesions were also found in 4 of 23 women (17.4%) undergoing hysteroscopy for RPOC after abortion. Patient age, gravidity, parity, and the interval between the index pregnancy and treatment for RPOC were not associated with postoperative IUA.
CONCLUSION(S): Hysteroscopic treatment for RPOC had a 3.6% incidence of severe intrauterine adhesions formation in this descriptive series. Women with RPOC occurring after delivery by cesarean section are particularly at risk for development of IUA.
评估宫腔镜治疗妊娠物残留（RPOC）后宫腔粘连（IUAs）的发生率和危险因素。
回顾性队列研究。
妇科内镜室。
2009 年至 2013 年期间，共有 167 名患者因 RPOC 被转诊至我院。
手术性宫腔镜治疗 RPOC 以及门诊宫腔镜随访以评估是否存在 IUA。
我们研究了人口统计学特征、产科参数和手术变量，以评估哪些因素可能与 IUA 形成有关。
在 167 名接受 RPOC 治疗的患者中，84 名（50.3%）在手术性宫腔镜治疗后进行了随访宫腔镜评估，这些患者被纳入研究。16 例（19.0%）发现存在 IUA，其中仅 3 例（3.6%）为严重粘连。多变量分析显示，IUA 的存在与剖宫产术后 RPOC 相关（5 例 [50.5%] 发生 IUA，而阴道分娩后 49 例 [14.3%]）。在因流产而行宫腔镜治疗 RPOC 的 23 名患者中，也有 4 例（17.4%）发现存在 IUA。患者年龄、孕次、产次以及本次妊娠与 RPOC 治疗之间的间隔时间与术后 IUA 无相关性。
在本描述性系列研究中，宫腔镜治疗 RPOC 后严重 IUA 的发生率为 3.6%。经剖宫产分娩后发生 RPOC 的女性发生 IUA 的风险特别高。
