A preliminary study of the relationship between the uterine junctional zone and outcome of intrauterine adhesions / 解放军医学杂志

ABSTRACT

Objective To investigate the influence of degree of the injury in uterine junctional zone (JZ) of intrauterine adhesions (IUAs) patients on postoperative pregnancy outcomes by magnetic resonance imaging (MRI). Methods Design: Retrospective observational study. Setting: Navy General Hospital of PLA, Beijing. The study included ninety-two patients undergoing preoperative pelvic MRI from June 2011 to June 2014, and they were diagnosed as IUA by hysteroscopy, and hysteroscopic adhesiolysis was conducted under the guidance of abdominal ultrasound. All patients had tried to be pregnant for longer than six months. According to whether uterine junctional zone (JZ) was injured or not, the patients were divided into two groups group A (JZ was normal) and group B (JZ was partly or completely injured). All patients were followed up with telephone comunication regarding postoperative pregnancy outcome within two weeks in August 2015. The difference of severity of IUAs and pregnancy outcome was compared. Results There were 51 and 41 IUAs cases in Group A and Group B, respectively. According to European Society of Gynecological Endoscopy (ESGE) classification of IUAs, the number of mild, moderate and severe IUA cases were 20, 24 and 7, respectively, in group A; and 10, 12 and 19, respectively, in group B. The proportion of severe IUA cases was significantly higher in group B than in group A (P=0.001). Forty-six of 92 IUAs cases had been pregnant, the pregnancy rate was 50%. Among them 4 had conceived twice. Twenty-one IUAs had given live birth (one had given birth to a pair of twins), and 10 were in pregnancy. The live-birth delivery rate was 42%, and the pregnancy loss rate was 38%. Thirty-one and fifteen IUAs had been pregnant in group A and group B respectively, the pregnancy rate was higher in group A than in group B (60.8% vs 36.6%, P=0.021). The live-birth delivery rate was higher in group A than in group B (47.1% vs 31.3%, P=0.365), while the pregnancy loss rate was higher in group B than in group A (29.4% vs 56.3%, P=0.117), but the difference was not statistically significant. Conclusions The severity of IUAs was associated with the degree of injury of uterine JZ. Especially, when JZ was completely injured, it was meant to have severe IUAs. For IUAs, injured uterine JZ may significantly decrease the postoperative pregnancy rate and live-birth delivery rate, and increase in the pregnancy loss rate. Evaluation of JZ may offer new perspectives to estimate the severity of IUA and the outlook of pregnancy. So it is recommended to evaluate the degree of injury of uterine JZ as an independent predictor for postoperative pregnancy outcome of IUAs. For severe IUAs, once JZ was extensively or completely injured, the outcome of pregnancy may be very poor.