Feng Qing, Gao Bingsi, Huang Huan, Woo Jeffrey Je-Chuen, Zou Lingxiao, Zhao Xingping, Cheng Chunxia, Xu Dabao
Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha 410013, China.
Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA.
Ann Transl Med. 2020 Feb;8(4):51. doi: 10.21037/atm.2019.09.123.
Intrauterine adhesion (IUA) is caused by adhesion of the uterine cavity due to the damage of endometrium. Hysteroscopic adhesiolysis (HA) is the main treatment. The objective of the study was to investigate the obstetrical outcome in the third trimester of women who previously underwent HA.
We performed a retrospective cohort study in the university-affiliated hospital. A total of 146 women with a history of HA who had given birth in their third trimester from May 2012 to May 2019 were enrolled (study group), while 292 women with a negative history of HA were matched for maternal age, gravidity, parity, and delivery year. The parameters of obstetrics and infants were investigated to evaluate the change in the third trimester of women with a history of HA.
There was no significant difference between study and control groups in gestational weeks, nor in fetal gender distribution, birth weight, Apgar score, fetal distress, and neonatal intensive care unit (NICU) admissions after delivery (P>0.05). In addition, when compared with the control group, women with a history of HA were at a higher risk of placental risks (P<0.05), such as placenta previa (11.6% versus 3.1%), abnormally invasive placenta (AIP) (33.56% versus 2.7%), and retained placenta (42.5% versus 8.6%). This resulted in a significantly higher postpartum hemorrhage (PPH) rate in the study group as compared with that in the control group (8.9% versus 1.0%, P<0.05). Such cases were more likely to be found in patients with severe IUA compared with those who were assessed as mild and moderate.
The history of HA might be an important risk factor inducing placental problems and PPH in the third trimester. More attention should be paid to the labor of pregnant women with a history of HA.
宫腔粘连（IUA）是由子宫内膜损伤导致的宫腔粘连引起的。宫腔镜粘连松解术（HA）是主要的治疗方法。本研究的目的是调查既往接受过HA治疗的女性在孕晚期的产科结局。
我们在大学附属医院进行了一项回顾性队列研究。纳入了2012年5月至2019年5月期间在孕晚期分娩的146例有HA病史的女性（研究组），同时匹配了292例无HA病史的女性，匹配因素包括产妇年龄、孕次、产次和分娩年份。调查产科和婴儿的参数，以评估有HA病史女性在孕晚期的变化。
研究组和对照组在孕周、胎儿性别分布、出生体重、阿氏评分、胎儿窘迫以及产后新生儿重症监护病房（NICU）收治情况方面均无显著差异（P>0.05）。此外，与对照组相比，有HA病史的女性发生胎盘相关风险的几率更高（P<0.05），如前置胎盘（11.6%对3.1%）、胎盘植入异常（AIP）（33.56%对2.7%）和胎盘残留（42.5%对8.6%）。这导致研究组的产后出血（PPH）率显著高于对照组（8.9%对1.0%，P<0.05）。与轻度和中度IUA患者相比，重度IUA患者更易出现此类情况。
HA病史可能是孕晚期诱发胎盘问题和PPH的重要危险因素。对于有HA病史的孕妇分娩应给予更多关注。
