Risk Factors for Intrauterine Adhesions in a Black African Population - Nigerians

Abstract

Background: Intrauterine adhesions are associated with certain uterine procedures such as dilatation and curettage, open myomectomy and Cesarean section as well as some infections. Objectives: To determine the most important risk factors for intrauterine adhesions among Black Africans Study design, setting and subjects: This was a retrospective study conducted at Nordica Fertility Center (NFC). A total of 905 patients from three cities - Lagos, Abuja and Asaba, who consulted for infertility related problems and on whom hysteroscopy was performed between January 2005 and November 2014, were studied. Main outcome measures: Performance of different uterine surgeries, type and number of different uterine surgeries performed, and presence or absence of intrauterine adhesions. Results: A total of 905 women on whom hysteroscopy was performed were included in the study among whom 264 (29.2%) were positive for intrauterine adhesions. Women with IUA were significantly older (t=5.34, P-value=0.00001) than those without IUA. IUA was common among women who were Chief Executives (21/52, 40.4%). The overall mean [± sd] number of myomectomy (0.58 [0.66]) and of D&C (1.68 [1.82]) were significantly higher in IUA-positive women than in IUA-negative women (t=10.66, P-value=0.000001; t=4.52, P-value=0.00001). The ratio of D&C per woman was 1.70 per woman in IUA-positive women compared to 1.1 per woman in IUA negative women. Women with IUA were about 2½ times more likely to have had open myomectomy than those without IUA (Crude odds ratio=2.36, 95% CI:1.75, 3.16) and were just about twice as likely to have had D&C compared to those without IUA (Crude odds ratio=1.92, 95% CI:1.42, 2.60). Correlation coefficient study indicates that IUA was significantly (P-value<0.05) associated with performing all uterine and adnexal operations especially D&C (r=0.023, t=4.42), open myomectomy (r=0.017, t=3.45), Cesarean section (r=0.037, t=4.39), ovarian cystectomy (r=0.06, t=4.86) and salpingectomy (r=0.111, t=6.37). When the number of uterine surgeries performed was considered, IUA significantly (P-value<0.05) correlated with age (r=0.097, t=12.42), Body Mass Index (r=0.162, t=15.45), and with the number of D&C performed (r=0.014, t=2.16). Conclusion: Uterine procedures like open myomectomy, Dilatation and Curettage and Caesarean section as well as adnexeal surgeries and the number of times these procedures are carried out are important risk factors for uterine adhesions in infertile black African women. Mitigating these risk factors can help reduce the incidence of intrauterine adhesions in these women and improve their fertility.