| Objective: To analyze the natural pregnancy rate,full-term delivery rate,premature delivery rate,unplanned pregnancy abortion rate,cesarean section rate,incidence of abnormal fetal position(breech,transverse position),placental abnormality(placenta accreta,adhesion;low placenta,placenta previa)in patients undergoing hysteroscopic mediastinectomy.The pregnancy complications and pregnancy outcomes were analyzed in order to provide reference for the clinical diagnosis and treatment of patients with mediastinal uterus with fertility requirements.Methods: Female patients with mediastinal uterus from 23 to 40 years old who was diagnosed in Qingdao Women’s and Children’s Hospital affiliated to Qingdao University from January 01 2013 to December 31,2020 were collected retrospectively,and hysteroscopic mediastinotomy was performed in our hospital.A total of 181 cases of were successfully followed up after operation.Selected controlled group: according to the principle of balanced selection,181 normal women of childbearing age were randomly selected as the control group according to the frequency matching of the normal pregnant women who underwent regular antenatal examination in our hospital in the same time according to the ratio of control group to study group = 1: 1.The main steps were as follows:(1)the clinical data of the two groups were collected and recorded,including the patient’s name,age,menstruation,marriage and childbearing history,auxiliary examination results,operation methods and so on.(2)record and analyze the average number of pregnancies,natural pregnancy rate,total abortion rate,unplanned pregnancy abortion rate,term delivery rate,cesarean section rate,abnormal placental position,placental abnormality(placenta accreta,adhesion;low placenta,placenta previa;placental abruption)in patients with mediastinal uterus before and after operation,and compare the corresponding clinical indexes with the control group.(3)according to the intraoperative findings,the patients were divided into complete uterine mediastinum group and incomplete uterine mediastinum group.The preoperative and postoperative pregnancies,natural pregnancy rate,total abortion rate,unplanned pregnancy abortion rate,term delivery rate,cesarean section rate,abnormal placental position,placental abnormality(placenta accreta,adhesion;low placenta,placenta previa;placental abruption)were analyzed and compared.Results:Part 1: 1.The average natural pregnancy rate before mediastinectomy in the experimental group was 99.48%(190 pm 191),while that in the control group was97.04%(295 pm 304).There was no significant difference between the two groups(χ 2 =2.396 pm 0.122).2.The median number of pregnancies before mediastinectomy was 1 in the experimental group and 2 in the control group,and there was significant difference between the two groups(P < 0.001).3.The total abortion rate before mediastinectomy in the experimental group was 90.58%(173 pm 191),in which the unplanned pregnancy abortion rate was 80.92%(140 max 173),and the total abortion rate in the control group was 28.62%(87max 304).Among them,the rate of unplanned pregnancy abortion was48.28%(42 shock 87).There was significant difference in total abortion rate and unplanned pregnancy abortion rate between the two groups(χ 2-180.575 P < 0.001;χ2=29.384 P < 0.001).Part 2: 1.The median number of pregnancies after mediastinectomy was 1 in the experimental group and 2 in the control group.There was significant difference between the two groups(P < 0.001).2.The average natural pregnancy rate after mediastinectomy was 70.88% in the experimental group and 97.04% in the control group,and there was significant difference between the two groups(χ 2=80.66 P < 0.001).3.The abortion rate after mediastinectomy in the experimental group was 24.18%(44 pm 182),in which the unplanned pregnancy abortion rate was 88.64%(39 pm 44),while that in the control group was 28.62%(87 pm 304).Among them,the unplanned pregnancy abortion rate was48.28%(42 pm 87).There was no significant difference in the total abortion rate between the two groups.There was a significant difference in the rate of unplanned pregnancy abortion(χ 2 = 1.141,P =0.285;χ 2 = 20.170 P < 0.001);4.The cesarean section rate after mediastinectomy in the experimental group was 67.94%(89 max 131),while that in the control group was 39.07%(84 pm 215).There was significant difference between the two groups(χ 2=27.037 P < 0.001).5.There was no significant difference in term delivery rate between the experimental group and the control group after mediastinectomy(91.6%vs.94.88%),and there was no significant difference in the incidence of placental abnormality,fetal position abnormality and neonatal weight.Part 3: 1.There was no significant difference in the number of pregnancies,natural pregnancy rate,total abortion rate and unplanned pregnancy rate before mediastinectomy between the complete mediastinal uterine group and the partial mediastinal uterine group.2.There was no significant difference in the number of pregnancies,natural pregnancy rate,total abortion rate and unplanned pregnancy rate after mediastinectomy between the complete mediastinal uterine group and the partial mediastinal uterine group.3.There was no significant difference in term rate,cesarean section rate,abnormal placental position rate,placental abnormality rate and neonatal weight between complete mediastinal uterine group and partial mediastinal uterine group.Conclusions: 1.Uterine mediastinal malformation does not affect the natural pregnancy rate,but uterine mediastinum can increase the pregnancy abortion rate.2.Hysteroscopic mediastinectomy can significantly improve the abortion rate,and does not increase the incidence of premature delivery,placental abnormality and fetal position abnormality,but increase the rate of cesarean section.3.There was no significant difference in pregnancy outcome between complete septal uterus and partial septal uterus,regardless of whether they were undergoing mediastinectomy or not. |
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