Re-evaluation And Prognosis Value Of Three Grading Criteria On Intrauterine Adhesions

Objective: To evaluate the uterine cavity state of patients with intrauterine adhesions by AFS grading criteria、China IUA grading criteria and ESGE grading criteria,and to analyze the correlations between the three grading criteria and the menstrual improvement and pregnancy outcome of the patients after treatment.It is expected to have a preliminary evaluation of the application value of the three grading criteria.Methods:From January 2014 to March 2016,101 patients with intrauterine adhesion diagnosed by hysteroscopy in the Second Hospital of Hebei Medical University were selected.A total of 134 hysteroscopy examinations and treatment were performed.(1)The hysteroscopy results(surgical records and video recordings)of 134 hysteroscopy examinations were re-graded with AFS grading criteria、China IUA grading criteria and ESGE grading criteria.Excluding 15 cases due to inconsistent scores of the two physicians.Statistical differences of the grads by the three grading criteria results were tested.(2)Analysis of the relationship between the new grading of the three grading criteria and the improvement of menstruation and pregnancy outcome of patients with intrauterine adhesions.Re-evaluation the prediction roles of three different grading criteria for menstrual improvement and pregnancy outcome were performed in patients with intrauterine adhesions.Results:1.119 hysteroscopy results were re-graded,the differences of grading between European grading criteria and AFS grading criteria,and that between European grading criteria and Chinese grading criteria were statistically significant(P<0.05).There was no significant difference between Chinese and AFS grading criteria(P > 0.05).2.There was no significant difference between the three criteria on the improvement of menstruation in patients with intrauterine adhesions(P>0.05).ESGE criteria had significant difference in pregnancy rate and live birth rate in patients with intrauterine adhesions(P<0.05),the pregnancy rate of mild to moderate intrauterine adhesions patients was significantly higher than that of severe intrauterine adhesions patients.However,there was no significant difference in pregnancy rate and live birth rate between different groups of patients with intrauterine adhesion by AFS criteria in China(P >0.05).Conclusions:1.The same group of patients was graded according to different scoring criteria,and the results were not all the same,that is,the same patients may have different degrees of mild,moderate and severe with different scoring standards.2.For the prediction of menstrual improvement,there was no significant difference among the three criteria.For patients with intrauterine adhesions of reproductive age,ESGE criteria can predict the outcome of pregnancy.3.This study recommends the use of ESGE criteria for patients with intrauterine adhesions.