Effectiveness and safety of amniotic membrane transplantation in preventing recurrence of uterine adhesion after transcervical resection of adhesions

Abstract

Objective To investigate the effectiveness and safety of amniotic membrane transplantation in preventing recurrence of intrauterine adhesions (IUA) after transcervical resection of adhesions (TCRA). Methods From December 2016 to August 2017, a total of 121 patients who underwent TCRA due to moderate or severe IUA in the Center for Reproductive Medicine of Renmin Hospital of Wuhan University were enrolled into this study. According to the odd-numbered and even-numbered operation days, they were divided into two groups: group A (n=76) for amniotic membrane transplantation, group B (n=45) for conventional treatment, induding intrauterine device (IUD) and absorbable biomedical membrane. The general clinical data, curative effects (uterine cavity recovery, menstrual volume changes, postoperative endometrial thickness) and incidence of postoperative adverse reactions were compared between two groups. Independent-samples t test was used to statistically compare the age, gestational age and endometrial thickness between two groups. Wilcoxon rank sum test was used to statistically analyze body mass index (BMI) and disease course. The composition ratio of IUA degree, menstruation improvement rate and adverse reaction rate were analyzed by chi-square test, continuity correction of chi-square test or Fisher′s exact test. The procedures followed in this study was in accordance with the ethical standards established by the Human Beings Test Committee of Renmin Hospital of Wuhan University, and was approved by the committee (Approval No. WDRY2016-Q007). Informed consent was obtained from each participate. Results ①There were no significant differences in the aspects of age, gestational age, BMI, disease course, composition ratio of abnormal menstruation types before TCRA and composition ratio of IUA degree between two groups (P>0.05). ② The therapeutic effects of TCRA in two groups were evaluated as follows. The recovery rate of uterine cavity in group A was 84.2% (64/76), which was significantly higher than that of 64.4% (29/45) in group B, the improvement rate of menstrual volume of group A was 75.0% (57/76), which was significantly higher than that of 37.8% (17/45) in group B, and the thickness of postoperative endometrium of group A was (4.2±1.6) mm, which was significantly higher than that of (3.6±1.5) mm in group B. All the above indexes between two groups were statistically significant (χ2=4.367, 16.485, 2.168; P=0.037, 0.05). Conclusions Amniotic membrane transplantation is one of the effective methods to prevent the recurrence of adhesion after TCRA of IUA patients. While, its long-term safety needs to be confirmed by large-sample randomized, controlled trials. Key words: Hysteroscopes; Uterine adhesion; Amniotic membrane transplantation; Recurrence; Women