Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology & Infertility, Johns Hopkins Medicine, 10751 Falls Rd, Suite 280, Lutherville, MD 21093, USA.
Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology & Infertility, Johns Hopkins Medicine, 10751 Falls Rd, Suite 280, Lutherville, MD 21093, USA; Divisions of Pediatric and Adolescent Gynecology and Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Central Drive, Building 10 Rm I-3340, Bethesda, MD 20892, USA.
J Gynecol Obstet Hum Reprod. 2021 May;50(5):101930. doi: 10.1016/j.jogoh.2020.101930. Epub 2020 Oct 3.
To determine whether progestin type or number of dilation and curettage procedures (D&Cs) were associated with intrauterine synechiae (IS) or pregnancy outcomes in patients conservatively treated for endometrial intraepithelial neoplasia (EIN) or endometrial cancer (EC).
We evaluated patients conservatively treated for EIN or EC from 2000 to 2017 at an academic center. IS were identified hysteroscopically. We calculated proportions for categorical variables and tested associations between D&C number, progestin, and pregnancy outcomes using Pearson chi-squared and Fisher's exact tests. A post-hoc power analysis indicated sufficient power to detect livebirth.
We analyzed 54 patients, 15 with EIN (28 %) and 39 with EC (72 %), with a mean age of 34 ± 1.2 years. Progestin treatment types included megestrol acetate (MA) (n = 24), MA with levonorgestrel intrauterine device (LngIUD) (n = 10), MA followed by LngIUD (n = 3), and LngIUD alone (n = 6). Mean number of D&Cs was 3.9 ± 0.9. Overall, 53 subjects underwent hysteroscopy; 10 (19 %) had IS. When D&Cs were grouped into 0-2, 3-4 and ≥5, each increase in D&C group had a 2.9 higher odds of IS (OR: 2.91, p = 0.04, CI: 1.05-10.02). LngIUD was associated with a nonsignificant 46 % decrease in the odds of IS (OR: 0.54, p = 0.66, CI: 0.08-2.87). Twenty-two women attempted pregnancy; 14 women achieved a total of 20 pregnancies and 9 women had total of 15 livebirths (41 % livebirth rate). The number of D&Cs and progestin treatment type were not associated with pregnancy outcomes.
Among 54 patients conservatively treated for EC/EIN, nearly 20 % developed IS. However, hysteroscopic and/or fertility treatments may improve pregnancy outcomes.
为了确定孕激素类型或刮宫次数与接受子宫内膜上皮内瘤变（EIN）或子宫内膜癌（EC）保守治疗的患者的宫腔粘连（IS）或妊娠结局之间是否存在相关性。
我们评估了 2000 年至 2017 年在学术中心接受 EIN 或 EC 保守治疗的患者。IS 通过宫腔镜检查确定。我们计算了分类变量的比例，并使用 Pearson 卡方和 Fisher 精确检验测试了 D&C 次数、孕激素与妊娠结局之间的关联。事后功效分析表明有足够的功效来检测活产。
我们分析了 54 名患者，其中 15 名患有 EIN（28%），39 名患有 EC（72%），平均年龄为 34 ± 1.2 岁。孕激素治疗类型包括甲羟孕酮（MA）（n = 24）、MA 联合左炔诺孕酮宫内节育器（LngIUD）（n = 10）、MA 序贯 LngIUD（n = 3）和 LngIUD 单独使用（n = 6）。D&C 次数的平均值为 3.9 ± 0.9。总体而言，53 名患者接受了宫腔镜检查；10 名（19%）患者有 IS。当 D&C 分为 0-2、3-4 和≥5 组时，每组 D&C 增加与 IS 发生的相关性比为 2.9（比值比：2.91，p = 0.04，95%置信区间：1.05-10.02）。LngIUD 与 IS 发生的几率降低 46%相关（比值比：0.54，p = 0.66，95%置信区间：0.08-2.87），但无统计学意义。22 名女性尝试妊娠；14 名女性共妊娠 20 次，9 名女性共分娩 15 名活产儿（活产率为 41%）。D&C 次数和孕激素治疗类型与妊娠结局无关。
在 54 名接受 EC/EIN 保守治疗的患者中，近 20%的患者发生了 IS。然而，宫腔镜和/或生育治疗可能会改善妊娠结局。
