Westendorp I C, Ankum W M, Mol B W, Vonk J
Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Hum Reprod. 1998 Dec;13(12):3347-50. doi: 10.1093/humrep/13.12.3347.
This prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of intrauterine adhesions. In 50 women, undergoing either a secondary removal of placental remnants more than 24 h after delivery, or a repeat curettage for incomplete abortions, ambulatory hysteroscopy was performed 3 months after the intervention. Intrauterine adhesions were found in 20 of the women (40%): five patients had Asherman's syndrome grade I, six had grade II, six had grade III and three had grade IV. In women with menstrual disorders a statistically significant 12-fold increased risk for Asherman's syndrome grade II-IV was found. Previous abortion as well as infection during surgery were associated with a mildly but non-significant increased risk. Based on our findings, hysteroscopy is recommended only in those patients who develop menstrual disorders, either after secondary intervention for placental remnants after delivery or after a repeat curettage.
这项前瞻性研究评估了产后胎盘残留二次清除或不全流产再次刮宫的女性中宫腔粘连的患病率，并评估了与宫腔粘连存在相关的危险因素。对50名女性进行了研究，她们要么在产后24小时后进行胎盘残留二次清除，要么因不全流产进行再次刮宫，在干预后3个月进行了门诊宫腔镜检查。20名女性（40%）发现有宫腔粘连：5例为I级阿谢曼综合征，6例为II级，6例为III级，3例为IV级。在月经紊乱的女性中，发现II-IV级阿谢曼综合征的风险显著增加了12倍。既往流产以及手术期间感染与风险轻度但无显著增加相关。根据我们的研究结果，建议仅对那些在产后胎盘残留二次干预后或再次刮宫后出现月经紊乱的患者进行宫腔镜检查。
