Safety and Efficacy of Amnion Graft in Preventing Reformation of Intrauterine Adhesions

Abstract

Study objective: To determine the safety and efficacy of amnion grafts in preventing the recurrence of intrauterine adhesions after hysteroscopic adhesiolysis in women with severe intrauterine adhesions.

Design: A retrospective matched cohort study including 120 patients treated during 62 months (Canadian Task Force classification II-2).

Setting: A tertiary referral center.

Patients: A total of 120 patients who underwent intrauterine adhesiolysis for severe intrauterine adhesions: 40 patients in the treatment group and 80 patients in the control group matched for age and adhesion scores. The mean duration of follow-up was 14.6 months.

Intervention: A Foley balloon with/without a fresh amnion graft was introduced into the uterine cavity after hysteroscopic adhesiolysis.

Measurements and main results: In both groups, the balloon was kept in place for 7 days, cyclic hormone treatment was given for 3 months, and second-look and third-look hysteroscopies were performed 1 and 3 months after the operation. Outcome measures included the incidence of the recurrence of intrauterine adhesions, the score of intrauterine adhesions (if present), and the impact of the surgery on the amount of menstrual flow. In the study group, the menstrual score at the end of 3 months was significantly higher, and the intrauterine adhesion score at third-look hysteroscopy was significantly lower compared with those in the control group. The incidences of the recurrence of intrauterine adhesions at third-look hysteroscopy in the treatment and control groups were 30% and 48.7%, respectively (p = .05). The adhesion scores at third-look hysteroscopy in the treatment and control groups were 1.3 and 2.1, respectively (p < .05).

Conclusion: The use of an amnion graft after intrauterine adhesiolysis appears to be beneficial in improving menstruation and reducing the recurrence of adhesion reformation.

Keywords: Amnion graft; Intrauterine adhesions; Intrauterine balloon.