Факторы риска рецидивирования внутриматочных синехий в репродуктивном возрасте

Abstract

Aim. To identify risk factors for recurrent intrauterine synechiae in women of reproductive age. Design. A comparative prospective study. Materials and methods. The study enrolled 89 female patients of reproductive age with confirmed intrauterine adhesions (IUA), according to hysteroscopy and morphology. Patients were divided into two groups depending on the course of IUA: main group (n = 45) — women with recurrent IUA (at least one episode during the year), and reference group (n = 44) — patients with IUA de novo. The mean age of patients in the main and reference groups was 36 ± 6 and 30 ± 3 years old, respectively. Results. A history of emmeniopathy was statistically more common in patients with recurrent IUA (odd ratio (OR) = 4.5; 95% confidence interval (CI): 1.7–12.3) as compared to women with IUA de novo (p < 0.05), diffuse adenomyosis (OR = 5.4; 95% CI: 2.2–13.6) (p < 0.05). Patients with morphologically confirmed chronic endometritis had a high risk of recurrent IUA (OR = 4.0; 95% CI: 1.6–9.7) (p < 0.05). The risk is several times higher after surgeries: repeated curettage of uterine cavity due to abnormal uterine bleeding (OR = 17.3; 95% CI: 5.8–51.3) (p < 0.001), a history of myomectomy due to a submucous myomatous nodule (OR = 7.4; 95% CI: 2.9–18.8) (p < 0.001), hysteroresectoscopic adhesiolysis with monopolar energy (OR = 4.4; 95% CI: 1.7–11.3) (p < 0.001). Conclusion. The mentioned risk factors of recurrent IUA make it possible to timely identify women with a high risk of the disease and undertake preventive measures. Keywords: intrauterine synechiae, recurrence, risk factors, reproductive age.