Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion
Objective To investigate the predictive value of endometrium-related indicators assessed by three-dimensional transvaginal ultrasound(3D-TVUS)on pregnancy outcome after hysteroscopic adhesiolysis(HA).Methods A total of 278 patients who underwent HA for fertility purposes at the Fuxing Hospital,Capital Medical University,from June 2020 to February 2022 were included in this study.In the mid-luteal phase,3D-TVUS was performed to assess endometrial thickness,endometrial volume,and blood flow indices.Postoperative follow-up was conducted to evaluate uterine cavity and pregnancy outcomes.Based on the pregnancy outcome,patients were divided into a pregnancy group and a non-pregnancy group.Univariate analysis and multivariate Logistic regression analysis were performed to determine the factors influencing clinical pregnancy.The predictive value of these factors for clinical pregnancy was evaluated by using the area under the receiver operating characteristic curve.Results Among the 278 included patients,8 cases were lost to follow-up.Clinical pregnancy was achieved in 143 cases,while 4 cases experienced ectopic pregnancy and 123 cases did not achieve pregnancy.Multivariate analysis revealed that postoperative American Fertility Society(AFS)score,endometrial thickness,and volume were independent factors influencing clinical pregnancy(P<0.05).The Logistic regression model for predicting pregnancy after HA had an area under the curve of 0.827,a Youden index of 58.5%,sensitivity of 74.8%,and specificity of 83.7%.The optimal cutoff values for postoperative endometrial thickness and endometrial volume were 6.22 mm and 1.42 mL,respectively.Conclusion Postoperative AFS score,endometrial thickness,and volume were found to be predictive factors for pregnancy outcomes following hysteroscopic adhesion separation.They can serve as reference indices for patients in their postoperative pregnancy planning and assistive treatment decisions.
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