Obstetrical outcome in the third trimester after hysteroscopic adhesiolysis

Intrauterine adhesion (IUA) is caused by adhesion of the uterine cavity due to the damage of endometrium. Hysteroscopic adhesiolysis (HA) is the main treatment. The objective of the study was to investigate the obstetrical outcome in the third trimester of women who previously underwent HA.

We performed a retrospective cohort study in the university-affiliated hospital. A total of 146 women with a history of HA who had given birth in their third trimester from May 2012 to May 2019 were enrolled (study group), while 292 women with a negative history of HA were matched for maternal age, gravidity, parity, and delivery year. The parameters of obstetrics and infants were investigated to evaluate the change in the third trimester of women with a history of HA.

There was no significant difference between study and control groups in gestational weeks, nor in fetal gender distribution, birth weight, Apgar score, fetal distress, and neonatal intensive care unit (NICU) admissions after delivery (P>0.05). In addition, when compared with the control group, women with a history of HA were at a higher risk of placental risks (P<0.05), such as placenta previa (11.6% versus 3.1%), abnormally invasive placenta (AIP) (33.56% versus 2.7%), and retained placenta (42.5% versus 8.6%). This resulted in a significantly higher postpartum hemorrhage (PPH) rate in the study group as compared with that in the control group (8.9% versus 1.0%, P<0.05). Such cases were more likely to be found in patients with severe IUA compared with those who were assessed as mild and moderate.

The history of HA might be an important risk factor inducing placental problems and PPH in the third trimester. More attention should be paid to the labor of pregnant women with a history of HA.