The Impact of Preoperative Hematological Indicators on Postoperative Intrauterine Adhesion in Patients with Cesarean Scar Pregnancy Treated with Uterine Artery Embolization (UAE) Pretreatment Combined with Curettage

doi:10.3969/j.issn.1674-3245.2025.04.032

Abstract：Objective: To analyze the impact of preoperative hematological indicators on postoperative intrauterine adhesion in patients with cesarean scar pregnancy treated with uterine artery embolization (UAE) pretreatment combined with curettage. Methods: A retrospective analysis was conducted on 100 cases of cesarean scar pregnancy admitted to the First Affiliated Hospital of Anhui University of Science and Technology from May 2017 to December 2022. All patients received UAE pretreatment combined with curettage. Postoperative intrauterine adhesion was evaluated by hysteroscopy, and patients were divided into adhesion group (35 cases) and non-adhesion group (65 cases). General information and preoperative hematological indicators [white blood cell count (WBC), neutrophil percentage (NE%), beta-human chorionic gonadotropin (β-hCG)] were collected and compared between the two groups. The influence and predictive value of preoperative hematological indicators on postoperative intrauterine adhesion were analyzed. Results: The number of abortions, curettage times, and the proportion of intraoperative negative pressure ≥ 300 mmHg in the adhesion group [(2.66±0.58) times, (2.48±0.42) times, 54.29%] were higher than those in the non-adhesion group [(2.30±0.43) times, (2.14±0.47) times, 30.77%], with statistically significant differences (t=3.524, 3.578, x2=5.288; P<0.05). The levels of WBC, NE%, and β-hCG in the adhesion group [(13.72±3.41)×10^9/L, (57.76±7.55)%, (24.23±3.81)×10^3 IU/L] were higher than those in the non-adhesion group [(10.94±2.89)×10^9/L, (51.34±7.26)%, (20.79±3.67)×10^3 IU/L], with statistically significant differences (t=4.305, 4.159, 4.155, P<0.05). Multivariate logistic regression analysis showed that WBC (OR=1.472, 95% CI: 1.188–1.823), NE% (OR=1.097, 95% CI: 1.021–1.177), and β-hCG levels (OR=1.198, 95% CI: 1.007–1.425) were all risk factors for postoperative intrauterine adhesion (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) values for WBC, NE%, and β-hCG in predicting postoperative intrauterine adhesion were 0.800 (0.708–0.873), 0.721 (0.623–0.806), and 0.685 (0.584–0.774), respectively. The combined assessment had an AUC of 0.855 (0.770–0.917), which was significantly higher than that of NE% and β-hCG alone (Z=2.615, 3.317, P<0.05). Conclusion: Preoperative WBC, NE%, and β-hCG levels can effectively evaluate the occurrence of postoperative intrauterine adhesion in patients with cesarean scar pregnancy, and have clinical value.