Effect of hysteroscopic adhesiolysis on recurrence, menstruation and pregnancy outcomes in patients with different degrees of intrauterine adhesions

Abstract

Objective: To study the recurrence, menstruation, and pregnancy outcome in patients with different degrees of intrauterine adhesions after hysteroscopic adhesiolysis.

Methods: From February 2017 to January 2020, 300 patients with intrauterine adhesions were recruited in this study. Patients were divided into group A (mild), group B (moderate) and Group C (severe). All patients underwent hysteroscopic adhesion separation. The uterine cavity was re-examined by hysteroscopy 3 months after surgery to evaluate the uterine cavity morphology, the degree and treatment effect of the intrauterine adhesions, menstrual volume, and pregnancy outcomes after 2 years.

Results: Compared to group A, the reconstruction rates of group B and C were lower, and group B was significantly higher than group C. The re-adhesion rate of group C was significantly higher than that of group A and group B, but no significant differences were observed between group A and group B. Furthermore, the efficacy of surgical treatment was evaluated. The treatment effect of group B and group C was not as obvious as that of group A, and group C was worse. The degree of intrauterine adhesions was negatively correlated with pregnancy rate and live birth rate of the fetus. Before treatment, there were significant differences in endometrial vascular index (EVI), blood flow Index (FI), endometrial volume (EV), and vascular blood flow index (VFI) among the three groups of patients with different degrees of adhesion. As the degree of adhesion increased before treatment, blood flow decreased. Surgery significantly improved the clinical symptoms of the three groups of patients. Moreover, the recovery of patients in group A was the best, followed by group B, and group C had the worst recovery.

Conclusion: The treatment effect and prognosis of patients were related to the degree of intrauterine adhesions before treatment. As the degree of intrauterine adhesions increased, the treatment effect and prognosis of patients became worse, and intensive treatment was needed. (Chinese Clinical Trial Registry, trial number ChiCTR1700026770, trial URL: http://www.chictr.org.cn/).

Keywords: Hysteroscopic adhesions separation; different degrees; intrauterine adhesions; menstruation; pregnancy outcome; recurrence.

Figure 1

Two-dimensional ultrasound imaging images of patients with intrauterine adhesions. A. The endometrium of the uterine cavity was interrupted, banded, and hypoechoic; B. The thickness of the endometrium of the uterine cavity was uneven, banded echo, and localized effusion; C. The endometrium of the uterine cavity was unclear.

Figure 2

Differences of menstrual volume among the 3 groups. *P<0.05, **P<0.01, ***P<0.001, Paired t test was used to compare before and after treatment within the group, LSD t test was used to compare the two groups.