Role of receptible endometrium in assessing severity of intrauterine adhesions: A preliminary study

Objective To assess the severity of intrauterine adhesions and predict postoperative pregnancy outcomes by receptible endometrium, so as to identify the value of the new method of classifying intrauterine adhesions. Methods Medical records of 160 patients with intrauterine adhesions (IUA) who had undergone transcervical resection of adhesions (TCRA) with clear operation video in department of obstetrics & gynecology, Navy General Hospital from January 2012 to June 2015 were retrospectively analyzed.During surgery, IUAs were classified according to European Society for Gynecological Endoscopy (ESGE) classification of IUA.After reviewing the records, according to the area of retained receptible endometrium of uterine cavity, IUAs were classified into three groups by the same surgeon: group A (n=72) with the retained area of receptible endometrium≥ 1/2 of uterine cavity and average age of (31.81±4.802) years; group B (n=34), 1/4 to 1/2 of uterine cavity receptible endometrium were retained with average age of (34.06±3.931) years; group C (n=54), ≤ 1/4 of uterine cavity receptible endometrium were retained or tubular cavity without any receptible endometrium retained with average age of (33.28±5.402) years.Patients in group A, B and C were considered as mild, moderate and severe intrauterine adhesions, respectively.In August 2015, we telephoned all IUAs patients asking about their pregnancy outcomes.The findings of our classification and the pregnancy outcomes were compared with those of ESGE. Results Theseverity grade of IUA defined by our classification and ESGE classification was closely correlative (r=0.799, P< 0.001) but with poor consistent (k=0.395, P< 0.001).The more severe IUA defined by ESGE tended to be classified as more severe IUA in our classification (χ²=64.332, P< 0.001).There were 144 cases with IUA trying to be pregnant, and 76 cases got pregnancy successfully.Of the 76 cases, 6 cases had been pregnant for twice with the total pregnancy of 82 times.The postoperative pregnancy rate of group A, B and C were 69.7% (46/66), 51.6% (16/31) and 29.8% (14/47) with statistically significant difference (P=0.015).The rate of taking baby home were 65.4% (34/52), 50.0% (8/16) and 42.9% (6/14) in group A, B and C without statistically significant difference (P=0.234).The pregnancy loss rate of group A, B and C were 17.3% (9/52), 31.3% (5/11) and 28.6% (4/14) without statistically significant difference (P=0.403).The pregnancy rate, taking baby home rate and pregnancy loss rate of each IUA level between the two classifications were not significantly different (P> 0.05). Conclusion The severity grade of IUA defined by our classification is closely correlated with ESGE with poor consistent.It shows negative correlation between retained receptible endometrium area and postoperative pregnancy outcomes.The results of the two classifications in predicting pregnancy outcomes are similar, but our classification is more simple than ESGE's, and more applicable in clinical practice.