Clinical, anamnestic data and treatment results in women with intrauterine adhesions

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Significance of cell therapy in treatment of patients with thin endometrium and Asherman’s syndrome. Russian Bulletin of Obstetrician-Gynecologist. 2024;(5):42-48

Objective — to evaluate the predisponding factors, clinical findings and treatment outcomes of different stages of intrauterine adhesions. Design: prospective cohort study. Subject and metods. 248 reproductive age women with intrauterine adhesions were examined and treated, their reproductive and surgical history was studied. The diagnosis was established intraoperatively and confirmed by histological examination. Depending on the severity of intrauterine adhesions, the patients are divided into 3 groups according to the hysteroscopic classification March. Depending on the severity of the process, complex treatment was carried out, including the surgical stage, antibacterial, physiotherapy, hormonal treatment. Control hysteroscopy for evaluation of the treatment was carried out in 3 months to patients of groups 2 and 3. Results. In 83.5% of patients, the previous surgical interventions were identified, as well as the relatively high incidence of chronic endometritis in groups confirmed by histological examination. The rate of reformation after treatment was 6.06% (n=10) in group I, 27.5% (n=11) in group II, 65.1% — in group III. The frequency of pregnancy in groups: in group I — 71.5% (n=113), in group II — 48.7% (n=19), in group III — 27.5% (n=11). Conclusion. Injury of the endometrium and infectious factor are crucial in the formation of intrauterine synechia. Complex treatment allows to improve long-term reproductive outcomes with a severe degree of intrauterine adhesions.

Keywords:

intrauterine adhesions

Ascherman’s syndrome

reformation of intrauterine adhesions

hysteroscopic adhesiolysis

Authors:

Khirieva P.M.

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russia, Moscow, Russia

Adamyan L.V.

Department of Reproductive Medicine and Surgery, Faculty of Postgraduate Professional Education, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia

SPIN RSCI: 9836-2713
Scopus AuthorID: 7006372422
ResearcherID: Q-1722-2018
ORCID: 0000-0002-3253-4512

List of references:

Adamyan LV, Kulakov VI. Endoskopiya v ginecologii. M.: Meditsina; 2000. (In Russ.)
Hirieva PM, Adamyan LV, Martynov SA. Sovremennye methody profilaktiki i lecheniya vnytrimatochnyh sinexii (obzor literatury). Ginecology. 2016;18(5):32-36. (In Russ.)
Hirieva PM, Martynov SA, Bystritskiy AA, Adamyan LV. Geneticheskie factory riska formirovaniya vnutrimatochnyh sinehiy. Problemy Reproduction. 2017;23(1):43-47. (In Russ.) https://doi.org/10.17116/repro201723143-47
Arakelyan AS, Martynov SA, Horoshun ND, Hirieva PM, Stepanyan AA, Danilov AYu, Kozachenko AV, Adamyan LV. Diagnostika i chirurgichesraya korrekstiya nesostoyatel’nosti rubza na matke posle kesareva secheniya s ispol’zovaniem laparoscopii i gisteroskopii. V kn.: Suxix GT, Adamyan LV (red.). Materialy XXIX kongressa «Novye texnologii v diagnostike i lechenii ginekologicheskih zabolevaniy». M. 7—10 June 2016. M. 2016;179-180. (In Russ.)
Arakelyan AS, Adamyan LV, Danilov AYu, Kozachenko AV, Stepanyan AA. Role of laparoscopy and hysteroscopy in the evaluation of uterine scar after cesarean section and its surgical correction. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S211. https://doi.org/10.1016/j.jmig.2015.08.753
Hadisaputra W, Handoko Y. The management of Asherman syndrome in gynecology. Med J Indones. 2013 May;22:2.
Fadare Oluwaseun O. Reproductive outcome following hysteroscopic adhesiolysis in patients with Asherman`s syndrome. World Journal of Laparoscopic Surgery. 2011 January-April;4(1):31-39.
Miriam MF, Hanstede MD, van der Meij E, Goedemans L, Emanuel MH. Results of centralized Asherman surgery 2003—2013. Fertility & Sterility. 2015.
March CM. Management of Asherman syndrome. Reprod Biomed Online. 2011;23:63-76.
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for management of untrauterine synechiae. J Minim Invasive Gynecol. 2010;17(1):1-7.
Yang J-H, Chen C-D, Chen S-U, Yang Y-S, Chen M-J. The influence of the location and extent of intrauterine adhesions on recurrence after hysteroscopic adhesiolysis. BJOG. 2015. https://doi.org/10.1111/1471-0528.13353
Sanad AS, Aboulfotouh ME. Hysteroscopic adhesiolysis: efficacy & safety. Arch Gynecol Obstet. 2016;294:1-6.
Xiao S, Wan Y, Xue M, Zeng X, Xiao F, Xu D, Yang X, Zhang P, Sheng W, Xu J, Zhou S. Etiology, treatment, and reproductive prognosis of women with moderate-to-severe intrauterine adhesions. International Journal of Gynecology and Obstetrics. 2014;125 (2014):121-124.
Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome — one century later. Fertil Steril. 2008;89(4):759-779.
Adesiyun AG, Zayyan MS, Eka А, Williams IO, Ojabo A. Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: a descriptive study. Open Journal of Obstetrics and Gynecology. 2014;4: 95-99. https://doi.org/10.4236/ojog. 2014.42017
Pinar H. Intrauterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol. 2007;19:207-214.
Palter F. Poly spyrou. Asherman’s syndrome: Etiologic factors, patterns of pregnancy loss and treatment results. Results from an international registry. Fertility and Sterility. 2003;80:26-37.
Schenker JG. Etiology of and therapeutic approach to synechic uteri. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1996;65:109-113.
Chen Y, Liu L, Luo Y, Chen M, Huan Y, Fang R. Prevalence and impact of chronic endometritis in patients with intrauterine adhesions: a prospective cohort study. Journal of Minimally Invasive Gynecology. 2017 January;24:1.
Bhandari Sh, Bhave P, Ganguly I, Baxi A, Agarwal P. Reproductive outcome of patients with Asherman`s syndrome: a SAIMS experience. J Reproductive Infertil. 2015;16(4):229-235.
Tsui K, Lin L, Cheng J, Teng S, Wang P. Comprehensive treatment for infertile women with severe Asherman syndrome. Taiwanese Journal of Obstetrics & Gynecology. 2014;53:372-375.
Kresowik JD, Syrop CH, Van Voorhis BJ, Ryan JL. Ultrasound is the optimal choice for guidance in difficult hysteroscopy. Ultrasound Obstet Gynecol. 2012;39:715-718.
Zikopoulos KA, Kolibianakis EM, Platteau P, de Munck L, Tournaye H, Devroey P, et al. Live delivery rates in subfertile women with Asherman’s syndrome after hysteroscopic adhesiolysis using the resectoscope or the versapoint system. 2004;8:720-725.
Fedele L, Vercellini P, Viezzoli T, Ricciardiello O, Zamberletti D. Intra-uterine adhesions: current diagnostic and therapeutic trends. Acta Eur Fertil. 1986;17:31-37.
Valle RF, Sciarra JJ. Intra-uterine adhesions: hysteroscopic diagnosis, classiﬁcation, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158:1459-1470.
Pabuёccu R, Atay V, Orhon E, Urman B, Ergün A. Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility. Fertil Steril. 1997;68:1141-1143.
Capella-Allouc S, Morsad F, Rongiures-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod. 1999;14:1230-1233.
Fernandez H, Al-Najjar F, Chauveaud-Lambling A, Frydman R, Gervaise A. Fertility after treatment of Asherman’s syndrome stage 3 and 4. JMIG. 2006;13(5):398-402.
Thomson ATM, Abbott JA, Kingston A, Lenart M, Vancaillie TG. Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes. Fertil Steril. 2007;87(2):405-410.
Yasmin H, Nasir A, Noorani KJ. Hysteroscopic management of Asherman’s syndrome. J Pak Med Assoc. 2007;57(11):553-555.
Dawood A, Al-Talib A, Tulandi T. Predisponding factors and treatment outcome of different stages of intrauterine adhesions. J Obstetrics Gynaecol Can. 2010;32(8):767-770.
Panayotidis C, Weyers S, Bosteels J, van Herendael B. Intrauterine adhesions (lUA): has there been progress in understanding and treatment over the last 20 years? Gynecol Surg. 2009;6:197-211.

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