Analysis of influencing factors of adverse pregnancy outcome in patients with intrauterine adhesion
Objective To explore the factors affecting pregnancy outcomes in patients with intrauterine adhesion(IUA)after the intrauterine endo-scopic transcervical resection of adhesion(TCRA).Methods A total of 336 pregnant women with IUA treated by TCRA in the Reproductive Center of the Second Affiliated Hospital of Soochow University from January 2017 to January 2023 were selected,and they were divided into two groups according to their pregnancy outcomes:the normal pregnancy group(245 cases)and the group with adverse pregnancy outcomes(91 cases).Uni-variate analysis and a multivariate logistic regression model were used to identify the risk factors associated with adverse pregnancy outcomes in IUA.Nomogram predictive models were also constructed to predict the likelihood of adverse pregnancy outcomes in IUA.The receiver operating characteristic curve was used to evaluate the prediction efficiency of the model,decision curve analysis was performed to analyze the actual applica-tion efficiency of the nomogram model.Results Of the 336 IUA patients,245 patients were pregnant,with a pregnancy rate of 73％.The risk factors that have been significant for the postoperative pregnancy outcomes of IUA patients were the artificial abortions and the times of operations of the uterine cavity,and sodium hyaluronate gel during TCRA was the protective factor affecting the postoperative pregnancy outcomes in IUA patients(P＜0.05).The nomogram prediction model achieved an AUC of 0.877(95％CI.0.842-0.911),with a sensitivity of 0.793 and a specificity of 0.882,indicating that the nomogram prediction model had high predictive value.The Hosmer,Lemeshow test showed x2=6.961,P=0.224,indicating that the model was well calibrated.Conclusion Times of artificial abortion and intrauterine surgeries are risk factors affecting the postoperative preg-nancy outcomes in IUA patients.The use of sodium hyaluronate gel can help uterine recovery to reduce the probability of intrauterine adhesion complications and improve the pregnancy rate.The prediction model effectively forecasts patients'recurrence risk and provides guidance for corre-sponding preventive measures.
Intrauterine adhesionTranscervical resection of adhesionPregnancyRisk factorsPrediction model
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