Reproductive outcomes after hysteroscopic removal of retained products of conception in patients with intrauterine adhesions: a single-center retrospective study of 400 cases

doi:10.3969/j.issn.1006-7795.2026.02.018

Abstract

Abstract: Objective To investigate the relationship between intrauterine adhesions (IUA) detected under hysteroscopy during retained products of conception (RPOC) removal and postoperative reproductive outcomes, including postoperative IUA, pregnancy rate, and mode of conception, and to explore factors affecting postoperative live birth. A predictive model for reproductive outcomes was also established.Methods Clinical data of 400 patients who underwent hysteroscopic RPOC removal at Fuxing Hospital, Capital Medical University from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into adhesion (n=150) and non-adhesion (n=250) groups according to intraoperative hysteroscopic findings. Baseline characteristics and postoperative reproductive outcomes were compared. Multivariate Logistic regression was used to identify factors associated with postoperative live birth, and a predictive model was evaluated using receiver operating characteristic (ROC) curve analysis.Results The adhesion group had significantly higher rates of previous curettage and prior IUA history than the non-adhesion group (P<0.05). Postoperative pregnancy rate was lower in the adhesion group (54.7% vs 79.2%, P<0.001). Among pregnant patients, the live birth rate was lower in the adhesion group than in the non-adhesion group ［72.0% (59/82) vs 83.3% (165/198), P=0.043］, and median time to conception was prolonged ［9 (6－15) months vs 5 (3－9) months, P<0.001］. Multivariate Logistic analysis showed that intraoperative IUA (adjusted OR=0.520, 95% CI: 0.353－0.774, P<0.001) and postoperative IUA (adjusted OR=0.571, 95% CI: 0.372－0.880, P=0.012) were independent risk factors for reduced live birth, while postoperative anti-adhesion therapy exerted protective effect (adjusted OR=1.492, 95% CI: 1.021－2.173, P=0.038). The RPOC fertility prediction model predicted postoperative live birth with an area under the curve (AUC) of 0.656, indicating moderate discriminative ability.Conclusion In RPOC patients, intraoperative IUA is associated with lower postoperative pregnancy and live birth rates but longer time to conception. Both intraoperative and postoperative adhesions reduce live birth rates, whereas postoperative anti-adhesion therapy may improve reproductive outcomes.

Key words: hysteroscopy, retained products of conception, hysteroscopic resection of retained products of conception, intrauterine adhesions, reproductive outcomes, prediction model

CLC Number:

Yang Xue, Ma Ning, Yang Lingling, Huang Xiaowu, Xia Enlan, Li Tinchiu. Reproductive outcomes after hysteroscopic removal of retained products of conception in patients with intrauterine adhesions: a single-center retrospective study of 400 cases[J]. Journal of Capital Medical University, 2026, 47(2): 360-365.

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