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History of hysteroscopic adhesiolysis treated intrauterine adhesions and subsequent risk of adverse obstetrical outcome: a matched cohort study of Chinese pregnant women
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  • Xiaocui Li,
  • Wei Hong,
  • Zhiping Wu,
  • Li Li,
  • Beiying Wang
Xiaocui Li
Tongji University Shanghai First Maternal and Infant Hospital

Corresponding Author:[email protected]

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Wei Hong
Tongji University Shanghai First Maternal and Infant Hospital
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Zhiping Wu
Tongji University Shanghai First Maternal and Infant Hospital
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Li Li
Tongji University Shanghai First Maternal and Infant Hospital
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Beiying Wang
Tongji University Shanghai First Maternal and Infant Hospital
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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
14 Jun 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
14 Jun 2023Assigned to Editor
14 Jun 2023Submission Checks Completed
14 Jun 2023Review(s) Completed, Editorial Evaluation Pending
19 Jun 2023Reviewer(s) Assigned
08 Nov 2023Editorial Decision: Revise Major