Friedler S, Margalioth E J, Kafka I, Yaffe H
Department of Obstetrics and Gynaecology, Bikur-Cholim Hospital, Jerusalem, Israel.
Hum Reprod. 1993 Mar;8(3):442-4. doi: 10.1093/oxfordjournals.humrep.a138068.
A prospective study was conducted on the incidence of intra-uterine pathology diagnosed by hysteroscopy in 147 women who underwent dilatation and sharp curettage due to spontaneous first trimester abortion. The diagnostic hysteroscopies were performed 4-6 weeks after the miscarriage, using CO2 as medium for uterine distention. In 38 patients (25.9%), uterine pathology was found, of whom 28 patients (19%) had intra-uterine adhesions (IUA). The incidence of IUA following only one abortion was 16.3% (16 out of 98 cases), all were of mild extent and filmy consistency, occupying less than one-quarter of the uterine cavity. The incidence of IUA after two abortions was 14% (3/21) but the incidence after three or more spontaneous abortions was significantly elevated (32%, 9/28), (P < 0.05, chi-square test). In addition, 58% of IUA diagnosed in the latter two groups were of a more severe extent. After a first miscarriage, occurrence of post-abortion IUA was not related to the serum oestrogen concentration on the day of curettage, nor was it related to any of the oestrogen treatment modalities used in this study. Although in most of these cases normal recovery of the endometrium was the rule, the high incidence of IUA diagnosed in this prospective study stresses the need for preventive treatment and close follow-up of patients after sharp curettage due to spontaneous abortion. Obviously oestrogen treatment alone did not prove to be effective and other treatment methods should be evaluated. The high incidence and severity of IUA in habitual aborters clearly justifies the performance of a diagnostic hysteroscopy as a standard evaluation.
对147名因孕早期自然流产而行扩张刮宫术的女性进行了一项前瞻性研究，以观察宫腔镜诊断的子宫内病变发生率。流产后4 - 6周进行诊断性宫腔镜检查，使用二氧化碳作为子宫扩张介质。在38例患者（25.9%）中发现子宫病变，其中28例患者（19%）有宫腔粘连（IUA）。仅一次流产后IUA的发生率为16.3%（98例中的16例），均为轻度，呈薄膜状，占据宫腔不到四分之一。两次流产后IUA的发生率为14%（3/21），但三次或更多次自然流产后的发生率显著升高（32%，9/28），（P < 0.05，卡方检验）。此外，后两组中诊断出的IUA有58%程度更严重。首次流产后，流产后IUA的发生与刮宫当天的血清雌激素浓度无关，也与本研究中使用的任何雌激素治疗方式无关。虽然在大多数这些病例中，子宫内膜正常恢复是常见情况，但这项前瞻性研究中诊断出的IUA高发生率强调了对因自然流产而行刮宫术的患者进行预防性治疗和密切随访的必要性。显然，单独的雌激素治疗并未证明有效，应评估其他治疗方法。习惯性流产患者中IUA的高发生率和严重程度明确证明了将诊断性宫腔镜检查作为标准评估方法的合理性。
