Analysis of factors affecting the prognosis of patients with intrauterine adhesions after transcervical resection of adhesions.

OBJECTIVES: To study the factors affecting the prognosis of patients with intrauterine adhesions (IUAs) after transcervical resection of adhesions (TCRA), analyze the reproductive outcome, and guide prognostic improvements.

DESIGN: Prospective study.

SUBJECTS: Our study included 292 patients diagnosed with intrauterine adhesions who underwent follow-up office hysteroscopy at Shenyang Women's and Children's Hospital between June 2018 and June 2022.

INTERVENTIONS: Patients were divided into case (52 patients whose hysteroscopy results indicated the presence of intrauterine adhesions) and nocase (240 patients whose uterine cavity had returned to normal shape without obvious adhesion) groups based on the results of a 2-month follow-up hysteroscopy following transcervical resection of adhesions. Clinical data were collected and compared with various influencing factors, and the combined effect of these factors was assessed using multifactorial logistic regression analysis. A nomogram prediction model was constructed and internally validated based on multifactorial analysis.

MAIN OUTCOME MEASURES: Intrauterine re-adhesion observed at 2-months follow-up after transcervical resection of adhesions.

RESULTS: Postoperative re-adhesion occurred in 52 of 292 patients with intrauterine adhesions. Multifactorial binary logistic regression analysis showed that intrauterine adhesion barrier gel reapplication 5 days after transcervical resection of adhesions was a protective factor while the preoperative American Fertility Society scores demonstrated that severe intrauterine adhesions and chronic endometritis were risk factors (P <0.05). The results of the multifactorial analysis were used to build a nomogram model, and the area under the curve value of the nomogram model for predicting postoperative recurrence was 0.914 (95% confidence interval: 0.864-0.956). The bootstrap method was subsequently used to resample 1,000 times for internal validation. The results showed that the internal validation C-index was 0.9135 and that the calibration curve and ideal curve were well-matched.

CONCLUSION: The prognosis of patients with intrauterine adhesions after transcervical resection of adhesions is related to the severity of preoperative intrauterine adhesions, presence of chronic endometritis, and intrauterine adhesion barrier gel reapplication 5 days after transcervical resection of adhesions. Therefore, clinicians should monitor patients using targeted data to reduce recurrence risk after transcervical resection of adhesions and improve the prognosis of patients with intrauterine adhesions.