Decision Tree Model Predicts Live Birth after Surgery for Moderate-to-Severe Intrauterine Adhesions

Abstract

Background: After treatment of intrauterine adhesions, the rate of re-adhesion is high and the pregnancy outcome unpredictable and unsatisfactory. This study established and verified a decision tree predictive model of live birth in patients after surgery for moderate-to-severe intrauterine adhesions (IUAs).Methods: A retrospective observational study initially comprised 394 patients with moderate-to-severe IUAs diagnosed via hysteroscopy. The patients underwent hysteroscopic adhesiolysis from January 2013 to January 2017, in a university-affiliated hospital. Follow-ups to determine the rate of live birth were conducted by telephone for at least the first postoperative year. A classification and regression tree algorithm was applied to establish a decision tree model of live birth after surgery.Results: Within the final population of 374 patients, the total live birth rate after treatment was 29.7%. The accuracy of the model was 83.8%, and the area under the receiver operating characteristic curve (AUC) was 0.870 (95% CI 7.699-0.989). The root node variable was postoperative menstrual pattern. The predictive accuracy of the multivariate logistic regression model was 70.3%, and the AUC was 0.835 (95% CI 0.667-0.962).Conclusions: The decision tree predictive model is useful for predicting live birth after surgery for IUAs; postoperative menstrual pattern is a key factor in the model. This model will help clinicians make appropriate clinical decisions during patient consultations.

Alternativas terapéuticas para el manejo del síndrome de Asherman

“…Aunque la histeroscopia diagnóstica y quirúrgica constituye el tratamiento principal, la tasa de readherencia postoperatoria sigue siendo elevada, con un porcentaje de recurrencia de adherencias leves y moderadas del 20 al 60% y 62.5% de adherencias graves, por esta razón, su manejo sigue siendo un reto, fundamentalmente en la reducción de las tasas de recurrencia y la mejora de la función reproductiva (Wang et al, 2022;Zhu et al, 2022).…”