A Retrospective Real-World Data Analysis of Pregnancy Outcomes Among Women with a History of Hysteroscopic Intrauterine Adhesiolysis (HA), Other Intrauterine Surgery (IUs), or no Prior IUs
Author(s)
Malcolm G Munro, MD1, Coby Martin, MSc2, Mrinmoy Pratim Bharadwaz, MPhil3, Jatinder Kumar, MPharm4, Jared Miller, MSc5, Ruihong Wang, MSc5, Ian Feldberg, BEng (Hons)6.
1Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 2RWE/HEOR/ES, Axtria Inc., Toronto, ON, Canada, 3RWE/HEOR/ES, Axtria India Pvt. Ltd., Pune, India, 4RWE/HEOR/ES, Axtria India Pvt. Ltd., Gurugram, India, 5RWE/HEOR/ES, Axtria Inc., Berkeley Heights, NJ, USA, 6Rejoni Inc., Bedford, MA, USA.
1Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 2RWE/HEOR/ES, Axtria Inc., Toronto, ON, Canada, 3RWE/HEOR/ES, Axtria India Pvt. Ltd., Pune, India, 4RWE/HEOR/ES, Axtria India Pvt. Ltd., Gurugram, India, 5RWE/HEOR/ES, Axtria Inc., Berkeley Heights, NJ, USA, 6Rejoni Inc., Bedford, MA, USA.
Presentation Documents
OBJECTIVES: Intrauterine surgery can result in basilar endometrial trauma and the development of intrauterine adhesions (IUAs) that are typically treated with hysteroscopic adhesiolysis (HA). Whereas HA has been associated with detrimental obstetrical and neonatal outcomes, including miscarriage, preterm delivery, placenta accreta spectrum, and peripartum hemorrhage, these risks have not been well characterized in US populations. We sought to determine the incidence of adverse pregnancy outcomes among three cohorts of US women: Those with a history of HA, those with a history of intrauterine surgery (IUS) but not HA, and those with no history of IUS.
METHODS: We used a claims database to evaluate pregnancy outcomes, assigning women with IUS to one of two cohorts (History of IUA; IUS without HA); a third cohort without previous IUS was randomly selected. The three cohorts were propensity-score matched and analyzed over 41 months for the incidence of miscarriage, preterm delivery, placenta accreta spectrum (PAS), peripartum hemorrhage, and other outcomes.
RESULTS: Among women with pregnancies, preterm delivery was most common in the prior HA cohort (14.5%), followed by those with IUS without HA (10.1%) and the controls (8.4%), as was PAS (4.6% vs. 0.9% vs. 0.0%), and cesarean delivery (45.3% vs. 22.1% vs. 26.7%). Postpartum hemorrhage was most common in the IUS no HA cohort when compared to those with previous HA 25.0% and 17.7%), followed by those with no prior IUS (7.8%). A single miscarriage was experienced by 33.4%, 22.7%, and 13.3% of the HA no IUA, IUA, and no IUS cohorts, respectively.
CONCLUSIONS: A history of HA was associated with a greater rate of detrimental pregnancy outcomes than other IUS, particularly when compared to no prior IUS. This highlights the need to minimize endometrial trauma and resulting IUAs to reduce the risk of these adverse outcomes.
METHODS: We used a claims database to evaluate pregnancy outcomes, assigning women with IUS to one of two cohorts (History of IUA; IUS without HA); a third cohort without previous IUS was randomly selected. The three cohorts were propensity-score matched and analyzed over 41 months for the incidence of miscarriage, preterm delivery, placenta accreta spectrum (PAS), peripartum hemorrhage, and other outcomes.
RESULTS: Among women with pregnancies, preterm delivery was most common in the prior HA cohort (14.5%), followed by those with IUS without HA (10.1%) and the controls (8.4%), as was PAS (4.6% vs. 0.9% vs. 0.0%), and cesarean delivery (45.3% vs. 22.1% vs. 26.7%). Postpartum hemorrhage was most common in the IUS no HA cohort when compared to those with previous HA 25.0% and 17.7%), followed by those with no prior IUS (7.8%). A single miscarriage was experienced by 33.4%, 22.7%, and 13.3% of the HA no IUA, IUA, and no IUS cohorts, respectively.
CONCLUSIONS: A history of HA was associated with a greater rate of detrimental pregnancy outcomes than other IUS, particularly when compared to no prior IUS. This highlights the need to minimize endometrial trauma and resulting IUAs to reduce the risk of these adverse outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO55
Topic
Clinical Outcomes
Disease
SDC: Injury & Trauma, SDC: Pediatrics, SDC: Reproductive & Sexual Health, STA: Surgery