Effect of early second-look hysteroscopy on reproductive outcomes after hysteroscopic adhesiolysis in patients with intrauterine adhesion, a retrospective study in China

Xu, Weifeng; Zhang, Yuxue; Yang, Yang; Lin, Xiaona

doi:10.1016/j.ijsu.2017.11.040

Cited by 35 publications

(26 citation statements)

References 24 publications

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“…Previous studies have indicated that hormones, intrauterine balloons and intrauterine devices (IUD), achieved some curative effect in preventing IUAs, but there were no clear indicators as to the improvement of clinical symptoms and pregnancy rates of the patients (22)(23)(24)(25)(26). Abu Rafea et al (27) demonstrated that postoperative intrauterine placement of a Foley's catheter balloon exhibited no significant effect on childbirth and pregnancy (27).…”

Section: Discussionmentioning

confidence: 99%

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Zheng¹,

Xin

He³

et al. 2020

Exp Ther Med

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Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms 'hyaluronic acid', 'intrauterine adhesions', 'Asherman's syndrome', 'IUA', 'dilatation and curettage', 'abortion' and 'hysteroscopic' were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to-0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.

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Section: Discussionmentioning

confidence: 99%

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Zheng¹,

Xin

He³

et al. 2020

Exp Ther Med

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“…Xu et al . reported that an early second‐look hysteroscopic examination (within 2 months of TCRA) markedly increased the pregnancy and live birth rate.…”

Section: Discussionmentioning

confidence: 99%

“…Xu et al . reported that early second‐look hysteroscopy after hysteroscopic adhesiolysis (within 2 months) significantly improved IUA reproductive outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Sun

Shi

Liang

et al. 2020

Intl J Gynecology & Obste

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Objective:To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. Methods:A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children 's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75).Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. Results:The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). Conclusion:Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions. K E Y W O R D S Balloon dilatation; Early second-look; Intrauterine adhesion; Prognosis; Reproductive outcomes; Transcervical resection of adhesion 1 | INTRODUCTION Intrauterine adhesions (IUA), also known as Asherman syndrome, are a common cause of secondary infertility among women of childbearing age. Endometrial damage caused by intrauterine operations or infections are the major causes of IUA, which lead to partial or complete occlusion of the uterine cavity. 1 IUAs are often secondary to intrauterine operations such as dilation and curettage. 2 Most effected women have hypomenorrhea, amenorrhea, and periodic abdominal pain, but a few also have normal menstruation. 2,3 Due to the high rate of induced abortion in China, the incidence of IUA is also increasing. 4 The prevalence of IUA is reported to be approximately | 193 Sun ET AL.20% after induced abortion, but rises to 40% for women with multiple intrauterine operations. 5Hysteroscopy is the gold standard for clinical diagnosis and treatment of IUA, 6 and most confirmed cases are treated by transcervical resection of adhesion (TCRA). However, the recurrence rate is up to 62.5%. 7 Several methods have been reported for preventing IUA recurrence, such as hyaluronic acid gel, artificial cycle hormone therapy, intrauterine balloon, and intrauterine devices; however, the effects are still uncertain. 8 Therefore, it is important to find a standardized strategy for managing women with IUA after TCRA surgery. Xu et al. 9 reported that early second-look hysteroscopy after hysteroscopic adhesiolysis (within...

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“…5,6 Hysteroscopic adhesiolysis and adjuvant therapies-including hormones, intrauterine devices, intrauterine balloons, gels, and early secondary hysteroscopy-have been moderately successful in treating intrauterine adhesions. 4,[7][8][9][10] However, no clear improvement in clinical symptoms and pregnancy rates has been found among patients with moderate-to-severe intrauterine adhesions who have undergone such therapies. [7][8][9][10] Since 2006, amniotic membrane products have been widely used to prevent postoperative adhesion and endometrial regeneration after hysteroscopic adhesiolysis.…”

Section: Introductionmentioning

confidence: 99%

“…4,[7][8][9][10] However, no clear improvement in clinical symptoms and pregnancy rates has been found among patients with moderate-to-severe intrauterine adhesions who have undergone such therapies. [7][8][9][10] Since 2006, amniotic membrane products have been widely used to prevent postoperative adhesion and endometrial regeneration after hysteroscopic adhesiolysis. This approach has achieved a therapeutic effect on improving menstrual volume; however, the improvement with regards to rates of intrauterine adhesion recurrence and pregnancy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

Zheng

Zhu

Liu

et al. 2018

Intl J Gynecology & Obste

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Effect of early second-look hysteroscopy on reproductive outcomes after hysteroscopic adhesiolysis in patients with intrauterine adhesion, a retrospective study in China

Abstract: Early second-look hysteroscopic examinations within 2 months may increase the cumulative PR and LBR.

Cited by 35 publications

References 24 publications

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

Meta‐analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

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