Gu Liqin, Zhang Chunnian, Luo Jianxiu, Zhou Cuicui, Song Yunjing, Huang Xuemei
Department of Gynaecology, Ganzhou People's Hospital No. 16 Meiguan Avenue, Zhanggong District, Ganzhou 341000, Jiangxi, China.
Am J Transl Res. 2024 Jul 15;16(7):3164-3170. doi: 10.62347/AMEB4153. eCollection 2024.
To investigate the therapeutic efficacy and prognostic factors of combined administration of estriol valerate tablets and progesterone for the prevention of intrauterine adhesions (IUA) in patients with early missed abortion (EMA) after dilation and curettage.
Clinical data of 120 EMA patients undergoing dilation and curettage at Ganzhou People's Hospital from July 2021 to June 2023 were collected for this retrospective study. The 120 enrolled patients were divided into two groups, with 70 patients in the study group receiving both estriol valerate tablets and progesterone for the prevention of IUA, and 50 in the control group undergoing no such treatments at all. The therapeutic efficacy of IUA prevention in patients was compared between the two groups. Subsequently, patients who developed IUA were categorized into the adhesion group (n = 23) and those who did not into the non-adhesion group (n = 97). The clinical data of patients were compared between the adhesion group and the non-adhesion group. Both univariate and multivariate logistic regression analyses were performed to identify the risk factors of IUA in patients with EMA after dilation and curettage. Receiver Operating Characteristic (ROC) curves were drawn to analyze the predictive value of independent risk factors for IUA in patients with EMA after dilation and curettage.
The study group showed a notably higher excellent and good response rate than the control group in IUA prevention (92.00% vs. 82.00%, P = 0.035). Logistic regression analysis revealed that a history of multiple previous miscarriages (P: 0.018; OR: 0.120; 95% CI: 0.02-2.119), relatively small endometrial volume (P: 0.001; OR: 0.026; 95% CI: 0.003-0.210), relatively thin endometrial thickness (P: 0.001; OR: 32.123; 95% CI: 4.339-237.807) and lack of preventive treatment (P: 0.051; OR: 0.211; 95% CI: 0.048-0.935) were independent risk factors for the occurrence of IUA in patients with EMA after dilation and curettage. ROC curve-based analysis showed that these risk factors; encompassing, the number of previous miscarriages, endometrial volume, endometrial thickness and preventive treatment, had a notably higher efficacy in jointly predicting the occurrence of IUA in EMA patients following dilation and curettage in comparison to an individual risk factor alone.
The occurrence of IUA in patients with EMA following dilation and curettage is influenced by several factors, including the number of previous miscarriages, the volume and thickness of the endometrium, and preventive treatments. To minimize the risk of IUA, it is crucial to implement proactive interventions prior to uterine surgeries. It was found that a combination therapy involving estriol valerate tablets and progesterone could effectively prevent the development of IUA in patients with EMA after dilation and curettage.
探讨戊酸雌三醇片联合黄体酮预防早期稽留流产（EMA）患者刮宫术后宫腔粘连（IUA）的治疗效果及预后因素。
收集2021年7月至2023年6月在赣州市人民医院接受刮宫术的120例EMA患者的临床资料进行回顾性研究。将120例纳入研究的患者分为两组，研究组70例患者接受戊酸雌三醇片联合黄体酮预防IUA，对照组50例患者未接受任何此类治疗。比较两组患者预防IUA的治疗效果。随后，将发生IUA的患者分为粘连组（n = 23），未发生IUA的患者分为非粘连组（n = 97）。比较粘连组和非粘连组患者的临床资料。进行单因素和多因素logistic回归分析，以确定刮宫术后EMA患者发生IUA的危险因素。绘制受试者工作特征（ROC）曲线，分析刮宫术后EMA患者IUA独立危险因素的预测价值。
研究组在预防IUA方面的优良反应率显著高于对照组（92.00% vs. 82.00%，P = 0.035）。logistic回归分析显示，既往多次流产史（P：0.018；OR：0.120；95%CI：0.02 - 2.119）、子宫内膜体积相对较小（P：0.001；OR：0.026；95%CI：0.003 - 0.210）、子宫内膜厚度相对较薄（P：0.001；OR：32.123；95%CI：4.339 - 237.807）以及未进行预防性治疗（P：0.051；OR：0.211；95%CI：0.048 - 0.935）是刮宫术后EMA患者发生IUA的独立危险因素。基于ROC曲线的分析表明，这些危险因素，包括既往流产次数、子宫内膜体积、子宫内膜厚度和预防性治疗，与单个危险因素相比，在联合预测刮宫术后EMA患者发生IUA方面具有显著更高的效能。
刮宫术后EMA患者发生IUA受多种因素影响，包括既往流产次数、子宫内膜体积和厚度以及预防性治疗。为了将IUA风险降至最低，子宫手术前实施积极干预至关重要。研究发现，戊酸雌三醇片联合黄体酮的联合治疗可有效预防刮宫术后EMA患者IUA的发生。
