Objective To determine the value of hysteroscopy for the diagnosis and treatment of traumatic intrauterine adhesions after induced abortion. Design A retrospective study of 365 patients. Setting Shanghai Institute of Planned Parenthood Research, the International Peaceful Maternity and Children Health Hospital, and the Shanghai First Maternity and Infant Health Hospital. Subjects 365 patients with traumatic intrauterine adhesions after induced abortions were included in the study, of whom 351 complained of amenorrhoea or hypomenorrhea before treatment, and 186 of whom wanted to have a child. Interventions In all the patients, the diagnoses and types of intrauterine adhesions were confirmed by hysteroscopy, and the adhesions were separated using micro scissors and biopsy forceps under hysteroscopic view. Most procedures were carried out with ultrasound monitoring. Results In 346 out of 365 patients (94.8%) intrauterine adhesions were released successfully after 1–4 episodes of surgery. Of the 351 patients with amenorrhoea or hypomenorrhea before treatment, 294 (83.76%) had normal or near‐normal regular menstruation after therapy. Of the 186 patients who wanted to have a child and were followed up for more than 12 months after the withdrawal of contraception, 156 (83.87%) had intrauterine pregnancies. Among these 156 patients, 145 had full‐term pregnancies, with three instances of retained placenta and one of placental implantation, and 11 had early spontaneous abortions. Conclusion Hysteroscopy is of great value in the diagnosis and treatment of intrauterine adhesions after induced abortions. Patients were managed with few complications after hysteroscopic lysis. Most patients regained their fertility and normal regular menstruation.

Objective To evaluate the efficacy of hysteroscopic resection of submucous fibroids. Design A retrospective study of 99 cases. Setting Shanghai Institute of Planned Parenthood Research, Shanghai First Maternity and Infant Health Hospital and the Shanghai Jiading Gynaecological Endoscopy Centre. Subjects The study included 99 patients with submucous fibroids. Out of these, 84 had menorrhagia, 13 had menorrhagia with irregular bleeding and two had postmenopausal bleeding. Interventions Transcervical hysteroscopic resection was used to treat submucous myoma in all patients on one or two occasions. All patients were followed up, for between 6 months and 6 years. Those patients who desired a child underwent hysteroscopic tubal catheterization and hydrotubations to check whether the shape of the uterine cavity recovered after surgery. Results In 94 out of 99 patients, the menstrual pattern became normal; five patients remained hypermenorrhoeic. Two patients were treated with endometrial ablation using a thermal balloon, because of retained myoma within the uterine wall and persistent hypermenorrhoea. Both of these patients experienced hypomenorrhoea for more than 12 months. Only one patient required hysterectomy after 34 months, because of a retained intramural myoma, which had enlarged and caused a recurrence of her menorrhagia. Seven out of the 12 women who desired a child became pregnant. Conclusion Hysteroscopic resection is an effective method for the treatment of submucous fibroids and could replace hysterectomy for some patients. It can shorten the operation time and patients can recover more quickly. For those patients who desire a child, this technique is not only organsparing, but also avoids the intra-abdominal adhesions induced by laparotomy.Correspondence

Objective To evaluate the efficacy of hysteroscopy for diagnosis and treatment of missing intra‐uterine devices (IUDs). Design A retrospective study of 274 patients. Setting Shanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital. Subjects 274 patients with missing IUDs, who had previously undergone up to four unsuccessful attempts at IUD removal, were included in our study. Among them, 45 patients had been menopausal for more than 1 year. Interventions Hysteroscopy was used to detect and/or remove the missing IUDs or their broken pieces in all patients. Results In 237 out of 274 patients with missing devices, the IUDs or their broken pieces in the uterine cavity were detected by hysteroscopy. In 236 out of these 237 patients, the IUDs or their broken pieces were removed successfully under hysteroscopic view or after hysteroscopic location. In one case only a small piece of the IUD remained in the uterine wall because of breakage during extraction. The IUDs of the remaining 37 patients were not found in the uterine cavity: in 13 patients there was expulsion of IUDs; in two there were broken pieces embedded in the uterine wall; 14 patients had IUDs removed by laparoscopy, and eight IUDs were removed by laparotomy. Conclusion Our study indicates that hysteroscopy, sometimes with an ultrasound B‐scan or laparoscopic guide, is of great value not only for precise locating of the IUD, but also for its removal under direct vision, particularly in the management of patients with broken and/or embedded IUD pieces.