Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions after induced abortions: clinical analysis of 365 cases

Abstract

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.

Asherman syndrome—one century later

“…Hysteroscopic adhesiolysis using scissors or biopsy forceps (84,85) has the advantage that it permits dissection and avoids complications related to energy sources, and it possibly minimizes the destruction of endometrium. Surgery that uses energy sources either with the electrode or laser vaporization system could provide effective and precise cutting as well as good hemostasis, but there is a theoretical possibility of further endometrial damage (86,87).…”

“…Because of the possibility of recurrence of adhesions, all patients undergoing surgery for intrauterine endometrial adhesions or endometrial fibrosis must be counseled regarding the possibility of a repeat surgery (85). This is especially true if the adhesions are of severe degree (32).…”

Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome

“…Second, very few authors presented the results of treatment according to the presenting symptoms (1,6). Some women with Asherman's syndrome present with hypo-or amenorrhea, some with infertility, and others with recurrent pregnancy loss.…”

“…It is quite possible that the presenting symptom may affect the outcome. Third, the reproductive outcomes in many earlier reports were simply presented as crude pregnancy rate (1,2,6,11,12) without reference to the duration of follow-up and the cumulative conception rate, which is a much more refined method of presenting data on conception after treatment.…”

“…Many studies have reported on the reproductive outcome after treatment of Asherman's syndrome (1)(2)(3)(4)(5)(6)(7)(8)(9). However, very few analyzed the reproductive outcome systematically according to the various types of presentation, the severity of intrauterine adhesions, the menstrual pattern after surgery, and whether or not adhesions recurred after adhesiolysis.…”