Short-term reproductive outcomes analysis and prediction of the modified uterine stent treatment for mild to moderate intrauterine adhesions: experience at a single institution

Abstract

Background: To evaluate the efficacy of modified uterine stent in the treatment of mild-to-moderate intrauterine adhesions and explore the relative indicators affecting prognosis prediction.

Methods: A total of 115 patients with mild-to-moderate intrauterine adhesions received a modified uterine stent placement after hysteroscopy adhesiolysis. The second-look hysteroscopy operated after 3 months surgery, and the third-look hysteroscopy operated after 6 months surgery if necessary. The stent was removed when the cavity shape was repaired, then the reproductive outcomes were followed up one year.

Results: Menstrual blood volume, endometrial thickness and volume had increased significantly after 3 months surgery. The rates of cavity repaired were 86.96% (100/115) after 3 months surgery and 100% (115/115) after 6 months surgery cumulatively. Endometrial thickness after 3-months surgery was positively associated with uterine cavity shape repaired (P<0.01). The receive operating characteristic (ROC) curve showed the rate of uterine cavity shape repaired predicted by the model was 0.92, based on the endometrial thickness after 3-months surgery. The rate of pregnancy was 86.09% (99/115) in one year, while the rate of miscarriage accounted for 26.26% (26/99). The median time interval between stent removal and subsequent conception was 3 months. It showed adhesion recurrence was the risk factor for subsequent pregnancy (P<0.01).

Conclusions: A modified uterine stent placement under hysteroscopy was an effective approach for mild-to-moderate intrauterine adhesions, which is easy to operate and worthy for clinical promotion. Endometrial thickness measured by ultrasonography probably has predictive value in adhesion recurrence and subsequent pregnancy.

Trial registration: ChiCTR2100051524. Date of registration (retrospectively registered): 26/09/2021.

Keywords: Hysteroscopy; Intrauterine adhesions; Modified uterine stent; endometrial thickness; reproductive outcomes.

Fig. 1

The process description of treatment and ultrasonography: A1-2 A round-shaped stainless-steel IUD packed by an anti-adhesive membrane of Chitosan; B1-2 The modified uterine stent was in uterine cavity; C1-3 The types of IUAs; D The uterine cavity after adhesiolysis immediately; E The uterine cavity and the stent (Chitosan membrane had been degraded) at the second-look hysteroscopy; F1-3 Adhesion recurrence appeared as device incarceration at the second-look hysteroscopy; G The endometrial thickness measured by 2D- TVUS; H The endometrial volume measured by 3D- TVUS; I1 It prompted the stent incarcerated, I2 It prompted the cavity repaired well without the stent incarcerated. 2D-TVUS: two-dimensional transvaginal ultrasound; 3D-TVUS: three-dimensional transvaginal ultrasound

Fig. 2

Distribution of outcome

Fig. 3

Scatter plots of endometrial thickness and volume: A Scatter plots of endometrial thickness and volume before surgery. B Scatter plots of endometrial thickness and volume after 3-month surgery

Fig. 4

The ROC curve of the endometrial thickness predication model for uterine cavity shape repaired at the second look hysteroscopy: It predicted by the model is 0.92 (area under the curve =0.9873; sensitivity = 92.0%; specificity = 100%) based on endometrial thickness after 3-month surgery when the endometrial thickness was 7 mm

Fig. 5

The time interval between stent removal and subsequent conception distribution within one year: A The number and time interval distribution of conception; B Cumulative conception distribution with time interval

Fig. 6

Analysis the factors after 3-months surgery affecting the time interval between stent removal and subsequent conception: A Scatter plots of the endometrial thickness and the time interval：Pearson correlation P=0.9199, Spearman correlation P=0.6728; B Scatter plots of the endometrial volume and the time interval: Pearson correlation P=0.7813, Spearman correlation P=0.6654; C The relationship between adhesion recurrence and the time interval (P=0.4290)

Fig. 7

The ROC curve of the endometrial thickness and volume after 3-months surgery predication model for getting pregnant in one year: A The ROC curve of endometrial thickness; B The ROC curve of endometrial volume