Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Obstetrics and Gynecology, Xiaoshan Hospital of Zhejiang Province, Hangzhou, China.
Int J Gynaecol Obstet. 2022 Jan;156(1):89-94. doi: 10.1002/ijgo.13616. Epub 2021 Feb 24.
To investigate the factors influencing placenta accreta in pregnant women who previously underwent hysteroscopic adhesiolysis (HA).
This retrospective study enrolled 265 women with intrauterine adhesions (IUAs) at the Sir Run Run Shaw Hospital from January 2014 to December 2018. We followed up their pregnancy outcomes and maternal complications.
The menstrual pattern and gestational history before operation were significantly different between the live birth and pregnancy loss groups. The age, extent of cavity involved, type of adhesions, times of adhesiolysis performed, and time interval from surgery to pregnancy were not significantly different between these two groups. In the third trimester, 48 of 140 patients had 53 perinatal complications, including placenta accreta (27), gestational diabetes mellitus (10), pregnancy-induced hypertension (6), postpartum hemorrhage (4), intrahepatic cholestasis of pregnancy (2), placenta previa (1), oligohydramnios (1), and intrauterine growth restriction (1). Logistic regression analysis showed that extent of cavity involved and times of adhesiolysis performed were associated with placenta accreta.
The extent of cavity involved and times of adhesive separation surgeries were risk factors for placenta accreta in patients. The menstrual model and gestational history may provide the main predictive factors for pregnancy loss.
探讨既往行宫腔镜粘连松解术（HA）的孕妇发生胎盘植入的影响因素。
本回顾性研究纳入 2014 年 1 月至 2018 年 12 月在浙江大学医学院附属邵逸夫医院就诊的 265 例宫腔粘连患者，随访其妊娠结局及母儿并发症。
活产组与妊娠丢失组患者的月经模式和术前妊娠史差异有统计学意义，两组患者的年龄、宫腔受累程度、粘连类型、粘连松解次数、手术至妊娠时间差异均无统计学意义。在孕晚期，140 例患者中有 48 例（34.3%）发生了 53 例围产期并发症，包括胎盘植入（27 例）、妊娠期糖尿病（10 例）、妊娠高血压（6 例）、产后出血（4 例）、妊娠肝内胆汁淤积症（2 例）、前置胎盘（1 例）、羊水过少（1 例）和胎儿宫内生长受限（1 例）。Logistic 回归分析显示宫腔受累程度和粘连松解次数与胎盘植入有关。
宫腔受累程度和粘连松解次数是患者发生胎盘植入的危险因素。月经模式和妊娠史可能为妊娠丢失提供主要的预测因素。
