Introduction
Intrauterine adhesions (IUAs) characterized by partial or complete obliteration of the uterine cavity and/or cervical canal are considered one of the main reproductive system diseases 1-3. They are caused by intrauterine operation-related trauma to a gravid uterine cavity or nongravid endometrium or intrauterine infection4-6. IUAs may cause one or more clinical symptoms, such as menstrual disturbances, periodic abdominal pain or recurrent pregnancy loss, and have a debilitating impact on the quality of life in childbearing-age women 4,5,7.
Hysteroscopic adhesiolysis (HA), which aims to restore regular menstruation and a normal uterine cavity, is the gold standard for diagnosing and treating IUAs in women with fertility requirements 8-10. The menstrual pattern outcomes and reproductive performance, including conception rate, miscarriage rate and live birth rate, following HA management of IUAs have been frequently described, and most studies have reported relatively favorable outcomes 11-21. However, only a few studies have focused on obstetric outcomes, and the sample sizes of the existing studies were relatively small 15,22-25.
In this study, using a large retrospective cohort of pregnant Chinese women, we compared the rates of pregnancy complications, placental abnormalities, postpartum hemorrhage (PPH) and adverse birth outcomes in pregnant women with a history of HA-treated IUAs and pregnant women with no history of IUAs and examined whether women with a history of HA-treated IUAs were at higher risk of adverse obstetric outcomes in subsequent pregnancies.