Construction Of Prediction Model For Pregnancy With Moderate To Severe Intrauterine Adhesions

Objectives 1.To compare the changes of three-dimensional doppler ultrasound indexes and endometrial VEGF expression levels before and after TCRA surgery in moderate to severe IUA patients;2.To follow-up pregnancy outcomes and analyze the related factors affecting pregnancy outcome;3.To establish a prediction model for pregnancy outcome of IUA patients.Methods Patients who were diagnosed with moderate to severe IUA by hysteroscopy admitted to the Obstetrics and Gynecology of Zhongda Hospital Affiliated to Southeast University from March 2020 to May 2021 were analyzed.Treatment was carried out according to the "Chinese Expert Consensus on Clinical Diagnosis and Treatment of Intrauterine Adhesion",and the postoperative pregnancy outcomes were followed up.According to the pregancy outcome,they were divided into a pregnancy group(51 cases)and a non-pregnant group(70 cases),and collecting basic patient information such as age,BMI,menstrual status,number of pregnancies,number of induced abortions,number of uterine operations,time of illness,pregnancy mode and three-dimensional doppler ultrasound indicators before and after surgery such as endometrial thickness,uterine artery S/D value,spiral artery PI,RI and subintimal blood flow VI,FI,VFI.Collecting the endometrial pretherapy and post-treatment,respectively,and the expression of VEGF protein in endometrial tissue was detected by immunohistochemistry.The data results obtained were analyzed statistically using EXCEL and The R Programming Language 3.6.0.Results 1.General information and comparison about the research object A total of 121 patients were included,according to pregnancy outcomes,they were divided into pregnancy group(51)and non-pregnant group(70).The basic information of the pregnant group and the non-pregnant group were compared.The results showed that two groups had statistically significant differences in age,number of abortions,AFS score,adhesion recurrence,menstrual status,and pregnancy mode(P<0.05),while BMI,pregnancy times,birth rate,degree of adhesion,the number of hysteroscopic operations,the number of TCRA and the duration of illness had no significant difference(P>0.05).2.Comparison of three-dimensional doppler ultrasound indicators before and after treatment Comparing the three-dimensional doppler ultrasound indexes of IUA patients before and after treatment,there were statistically significant differences in endometrial thickness,spiral artery PI,RI,VI,and VFI before and after treatment(P<0.05).There was no significant difference in FI,S/D of bilateral uterine arteries before and after treatment.(P>0.05).3.Comparison of three-dimensional ultrasound indexes before and after treatment between the pregnant group and the non-pregnant group Before treatment,there were significant differences in PI,RI between the the pregnant group and the nonpregnant group(P<0.05),endometrial thickness,VI,FI,VFI and S/D of bilateral uterine arteries had no significant differences(P>0.05).After treatment,there were significant differences in endometrial thickness,PI,RI,VI and VFI between the two groups(P<0.05),but there were no significant differences in FI and S/D of bilateral uterine arteries(P>0.05).4.Immunohistochemical results of VEGF There was a significant difference in the expression of VEGF in the endometrial between before and after treatment(P>0.05).Before treatment,the difference between pregnant group and the non-pregnant group was not statistically significant(P>0.05),But after treatment,the expression of VEGF of the two groups was significantly different(P<0.05).5.Correlation analysis of the effect of IUA on pregnancy outcomes The results of univariate logistic regression analysis showed that age,number of abortions,AFS score,adhesion recurrence,menstrual status,pregnancy mode,postoperative endometrial thickness,PI,RI and VI can enter the regression equation(P<0.05).Multivariate logistic regression results showed that adhesion recurrence(OR=0.386,95%CL: 0.150-0.997),and the higher AFS score(OR=0.606,95%CL: 0.425-0.863),the higher postoperative PI(OR=0.022,95%CL: 0.001-0.388)can increase the risk of pregnancy failure(P<0.05);menstrual recovery(OR=3.621,95%CL: 1.475-8.882),the higher VI(OR=1.066,95%CL: 1.003-1.133)can increase the possibility of pregnancy success(P<0.05).The above risk factors were incorporated into the nomogram to construct a nomogram model for predicting the outcome of IUA pregnancy.This nomogram model shows good discrimination and consistency,the area under the curve(AUC)of the receiver operating characteristic curve(ROC)= 0.779(95% C1: 0.697-0.860),indicating that the nomogram prediction model has a good effect on pregnancy.Selecting the appropriate cut-off point,when the cut-off T=0.406,the nomogram model has the largest Youden index,the sensitivity and specificity are 72.5% and 68.6%.Conclusions 1.The endometrial thickness,VI and VFI of IUA patients after treatment were significantly higher than those before treatment,and the PI and RI were significantly lower than those before treatment.2.The expression level of endometrial VEGF in the pregnant group was significantly higher than that in the nonpregnant group before and after treatment.3.The adhesion recurrence,AFS score,menstrual status,postoperative PI,endometrial VI are related to pregnancy outcome.4.A nomogram model was established to predict the pregnancy outcome of IUA patients,and the model has good accuracy by evaluating.