Strengths and Limitations
The major strengths of our study are the large sample size and the use
of PSM methods to eliminate the potential impacts of maternal age and
parity, prior history of abortion, mode of conception and pre-pregnancy
BMI. Furthermore, this study first explored the impacts of the number of
HA surgeries and the time interval from complete surgery to the date of
conception on obstetric outcomes. However, there are some limitations
that warrant attention. First, all participants of our study were from
one of the largest cities in China, which may limit the generalizability
of our findings. Second, due to lack of sufficient untreated pregnancies
with IUAs, we could not determine whether the increased risk of adverse
obstetric outcomes was attributed to the HA treatment or the disease of
IUAs itself. Finally, all data were from medical records, and due to
data inaccessibility, we could not obtain the AFS score of each IUA
case. However, we used the number of hysteroscopic surgeries a woman
underwent to reflect the severity of their IUAs. Scoring of IUA and
adjuvant treatment after HA are crucial factors of prognosis and more
prospective research are need to be further investigated whether these
factors have impact on obstetrical outcomes.