Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions after induced abortions: clinical analysis of 365 cases

Abstract

ObjectiveTo determine the value of hysteroscopy for the diagnosis and treatment of traumatic intrauterine adhesions after induced abortion.DesignA retrospective study of 365 patients.SettingShanghai Institute of Planned Parenthood Research, the International Peaceful Maternity and Children Health Hospital, and the Shanghai First Maternity and Infant Health Hospital.Subjects365 patients with traumatic intrauterine adhesions after induced abortions were included in the study, of whom 351 complained of amenorrhoea or hypomenorrhea before treatment, and 186 of whom wanted to have a child.InterventionsIn all the patients, the diagnoses and types of intrauterine adhesions were confirmed by hysteroscopy, and the adhesions were separated using micro scissors and biopsy forceps under hysteroscopic view. Most procedures were carried out with ultrasound monitoring.ResultsIn 346 out of 365 patients (94.8%) intrauterine adhesions were released successfully after 1–4 episodes of surgery. Of the 351 patients with amenorrhoea or hypomenorrhea before treatment, 294 (83.76%) had normal or near‐normal regular menstruation after therapy. Of the 186 patients who wanted to have a child and were followed up for more than 12 months after the withdrawal of contraception, 156 (83.87%) had intrauterine pregnancies. Among these 156 patients, 145 had full‐term pregnancies, with three instances of retained placenta and one of placental implantation, and 11 had early spontaneous abortions.ConclusionHysteroscopy is of great value in the diagnosis and treatment of intrauterine adhesions after induced abortions. Patients were managed with few complications after hysteroscopic lysis. Most patients regained their fertility and normal regular menstruation.