Baradwan Saeed, Shafi Dina, Baradwan Amira, Bashir Muhammad Salman, Al-Jaroudi Dania
Department of Obstetrics and Gynecology, Women's Specialized Hospital, King Fahad Medical City, Riyadh.
Faculty of Medicine, King Abdulaziz University, Jeddah.
Int J Womens Health. 2018 Feb 12;10:77-82. doi: 10.2147/IJWH.S151283. eCollection 2018.
Hysteroscopic adhesiolysis anatomically restores the uterine cavity in cases of Asherman's syndrome (AS); however, the extent of endometrial fibrosis could determine the pregnancy outcome.
To determine whether endometrial thickness could influence pregnancy outcome of hysteroscopic adhesiolysis in women with a history of AS.
This was a retrospective cohort study that included 41 women who attended Women's Specialized Hospital, King Fahad Medical City from December 2008 to December 2015, presented with a history of infertility or recurrent pregnancy loss, and were diagnosed with intrauterine adhesions and treated by hysteroscopic adhesiolysis. To analyze the causative factors of AS, history of curettage, miscarriage, postpartum hemorrhage, hysteroscopy, endometritis, and any uterine surgery were recorded. Patients were followed up for 2 years to account for pregnancy. Patients were divided into two groups based on measurement of endometrial thickness in the midsagittal plane at mid-cycle of a menstrual period. Group A consisted of 26 patients with endometrial thickness ≤5 mm, and group B included 15 patients with endometrial thickness >5 mm. The main outcome measures included endometrial thickness and pregnancy outcome.
Group A had significantly (<0.001) lower pregnancy rates compared with group B (38.4% versus 80%, respectively). Five of 10 pregnancies (50%) from group A miscarried, compared with 1 of 12 (8.3%) pregnancies in group B. This was statistically significant (<0.001).
Pregnancy rates were observed to be higher when the endometrium was >5 mm in thickness among patients with AS and miscarriage rates may be reduced in this group.
宫腔镜粘连分解术可在解剖学上恢复阿谢曼综合征（AS）患者的子宫腔；然而，子宫内膜纤维化的程度可能决定妊娠结局。
确定子宫内膜厚度是否会影响有AS病史女性宫腔镜粘连分解术的妊娠结局。
这是一项回顾性队列研究，纳入了2008年12月至2015年12月在法赫德国王医疗城妇女专科医院就诊的41名女性，她们有不孕或复发性流产史，被诊断为宫腔粘连并接受了宫腔镜粘连分解术治疗。记录刮宫、流产、产后出血、宫腔镜检查、子宫内膜炎及任何子宫手术史，以分析AS的致病因素。对患者进行2年随访以统计妊娠情况。根据月经周期中期矢状面测量的子宫内膜厚度将患者分为两组。A组由26名子宫内膜厚度≤5mm的患者组成，B组包括15名子宫内膜厚度>5mm的患者。主要观察指标包括子宫内膜厚度和妊娠结局。
A组妊娠率显著低于B组（分别为38.4%和80%，P<0.001）。A组10次妊娠中有5次（50%）流产，而B组12次妊娠中有1次（8.3%）流产，差异有统计学意义（P<0.001）。
AS患者中，子宫内膜厚度>5mm时妊娠率较高，且该组流产率可能降低。
