History of hysteroscopic adhesiolysis treated intrauterine adhesions and
subsequent risk of adverse obstetrical outcome: a matched cohort study
of Chinese pregnant women
Abstract
Objective: To examine whether women with a history of
hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs)
were at higher risk of adverse obstetrical outcomes in subsequent
pregnancies. Design: Retrospective cohort study.
Setting: A tertiary-care hospital in Shanghai, China.
Population: 114,142 pregnant women who were issued an antenatal
card and received routine antenatal care in Shanghai First Maternity and
Infant Hospital between January 2016 and October 2021. Methods:
From the cohort of 114,142 pregnant women, women with history of
HA-treated IUAs before this pregnancy (N=780) were compared with 4 women
with no history of IUAs (N=3010) matched on propensity score, maternal
age and parity, mode of conception, pre-pregnancy BMI and prior history
of abortion. Main outcome measures: Pregnancy complications,
placental abnormalities, postpartum hemorrhage and adverse birth
outcomes. Results : Compared with women with no
history of IUAs, women with a history of HA-treated IUAs were at higher
risks of preeclampsia (RR=1.69, 95% CI, 1.23, 2.33), placenta accreta
spectrum (RR=4.72, 95% CI, 3.9, 5.73) and previa (RR=4.23, 95% CI,
2.85, 6.30), postpartum hemorrhage (RR=2.86, 95% CI, 1.94, 4.23),
preterm premature rupture of membranes (RR=3.02, 95% CI, 1.97, 4.64)
and iatrogenic preterm birth (RR=2.86, 95% CI, 2.14, 3.81) . Those
women were also more likely to receive cervical cerclage (RR=5.63, 95%
CI, 3.95, 8.02) during pregnancy and hemostatic therapies after delivery
(RR=2.17, 95% CI, 1.75, 2.69). Moreover, we observed that the RRs of
those adverse obstetrical outcomes increased with the increasing number
of hysteroscopic surgeries. Conclusion: Our findings suggest
that pregnant women with a history of HA-treated IUAs, especially those
with a history of repeat HAs, are at higher risk of adverse obstetrical
outcomes. Key words: hysteroscopic adhesiolysis, obstetrical
outcomes, propensity score matching, cohort study