Outcome of intrauterine adhesion management at a Nigerian tertiary hospital: a five-year review

Abstract

Background: Intrauterine adhesion is a cause of menstrual abnormalities and infertility, which are leading complaints in gynaecological practice in Nigeria. Determining the aetiology and management option would help reduce this problem. The objective of this study was to determine the aetiology, mode of presentation, management option and outcome of intrauterine adhesionsMethods: A retrospective analysis of intrauterine adhesions at the University of Abuja Teaching Hospital over a five-year period from 2012 to 2016 was carried out. The case notes of the patients were retrieved from the records department and information extracted from these case notes using a questionnaire included the age, level of education, marital status, parity, complaints, predisposing factors, method of diagnosis, treatment method and outcome. Additional information was obtained from the theatre registered. The least follow up period was one year.Results: There were 82 patients diagnosed with Intrauterine Adhesion over the study period giving an incidence of 1.6%. Fifty-nine case notes were available for analysis. The case note retrieval rate was 72%. Majority of the patients were between the age range of 30-34 years (21, 35.6%). Those with tertiary level of education constituted the majority (34, 57%). Nullipara constituted 54.2% (32) of the total population. Menstrual abnormalities were the most common complaint with 93.2% and this includes those with menstrual abnormalities and other complaints. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation (28, 47.5%). Majority of the patients had partial intrauterine adhesions (51, 86.4%). All patients were treated with adhesiolysis, Foleys catheter insertion and hormonal therapy for 3 cycles. There was not statistical significance between those who had blind adhesiolysis and hysteroscopic adhesiolysis in terms of outcome. Restoration of menstrual flow was in 25, (42.4%) while 3, (5.1%) had miscarriges and an equal no of patients had term delivery.Conclusions: Dilatation and curettage is still a major predisposing factor in the development of intrauterine Adhesions. Blind adhesiolysis still has its place in the management of intrauterine adhesion in developing countries.

Ten-year review of the clinical presentation and treatment outcome of Asherman’s syndrome in university of Maiduguri teaching hospital, Borno State, Nigeria

“…The prevalence of Asherman's syndrome of 5.3% found in this study is similar to that found in Uyo, Southwestern Nigeria, higher than the 1.6% reported from Abuja and 1.4% reported from Kano but lower than 29.2% reported from Lagos Southern Nigeria. 3,4,6,13 This is the most reproductively active age group and the majority of the patients (94.5%) were married. They are therefore more likely to be pregnant and develop a pregnancy complication like abortions that can result in uterine evacuations which is a common cause of AS.…”

“…The commonest risk factor for the development of AS in this study was D&C. This was similar to the reports of other studies. 3,6,7,9 Endometrial injury induces ischemia and inflammatory reactions that lead to hypoxic cellular modifications and release of active substances leading to fibrosis and D&C is traumatic to the endometrium. 14,15 The other risk factors identified including myomectomy and caesarean sections may have operated through the same trauma to the endometrium that can occur during these procedures.…”

“…1,2 The true incidence of AS is unknown, as is dependent on the population studied and classification system used. 3,4 However it is steadily increasing particularly where dilation and curettage is still the most common method of pregnancy termination. 5,6 An incidence of 1.6%, 29.2%, 4.2% has been reported in Abuja, Lagos, Uyo, respectively.…”

“…3,4,6 The destruction of the basal is endometrium by trauma prevent endometrial thickening in response to ovarian steroids, leading to a spectrum of avascular scarring DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20220548 which ranges from filmy adhesion, dense bands or complete obliteration. [1][2][3][4][5] Vigorous curettage of the uterine cavity following a pregnancy complicated by infection is the commonest cause of Asherman's syndrome, 6 and earlier studies have shown that intrauterine adhesion was found in 25% of women who had dilation and curettage in the postpartum period, in 30.9% following missed abortion and 40% in those that had dilatation and curettage for retained products of conception after miscarriage or retained placenta. The risk also increases with the number of dilatation and curettage performed as 16% is recorded after the first dilatation and 32% after three or more.…”

“…3,4 Other documented risk factors include evacuation of hydatidiform mole, caesarean section, myomectomy, metroplasty, diagnostic curettage in a nongravid uterus, B-lynch, uterine artery embolisation, hysteroscopic surgery, insertion of intrauterine device complicated by infection, pelvic radiation, endometrial ablation, tuberculous endometritis, schistosomiasis endometritis and manual removal of placenta. [1][2][3][4][5][6][7][8] The clinical presentation of patients with Asherman's syndrome include menstrual abnormalities presenting as hypomenorrhea or secondary amenorrhea, others are; lower abdominal pain, dysmenorrhea, subfertility, recurrent miscarriage, fetal malposition and adherent placenta. Diagnosis requires a high index of suspicion with hysteroscopy being the gold standard, where direct visualization under magnification of the uterine cavity is possible.…”