Incidence Of Intrauterine Adhesions Research Articles

Intrauterine adhesion in ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA): a randomised controlled trial

BackgroundIntrauterine adhesion (IUA) can arise as a potential complication following uterine surgery, as the surgical procedure may damage the endometrial stratum basalis. The objective of this study was to assess and compare the occurrence of IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA) for managing first-trimester miscarriage.MethodsThis was a prospective, single-centre, randomised controlled trial conducted at a university-affiliated tertiary hospital. Chinese women aged 18 years and above who had a delayed or incomplete miscarriage of ≤ 12 weeks of gestation were recruited in the Department of Obstetrics and Gynaecology at the Prince of Wales. Recruited participants received either USG-MVA or EVA for the management of their miscarriage and were invited for a hysteroscopic assessment to evaluate the incidence of IUA between 6 and 20 weeks after the surgery. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes.Results303 patients underwent USG-MVA or EVA, of whom 152 were randomised to ‘USG-MVA’ and 151 patients to the ‘EVA’ group. Out of the USG-MVA group, 126 patients returned and completed the hysteroscopic assessment, while in the EVA group, 125 patients did the same. The incidence of intrauterine adhesion (IUA) was 19.0% (24/126) in the USG-MVA group and 32.0% (40/125) in the EVA group, showing a significant difference (p < 0.02) between the two groups. No significant difference in the menstrual outcomes at 6 months postoperatively between the two groups but more patients had miscarriages in the EVA group with IUA.ConclusionsIUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6–20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage.Trial registrationThe study was registered with the Centre for Clinical Research and Biostatics- Clinical Trials Registry (CCRBCTR), which is a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) (Unique Trial Number: ChiCTR1900023198 with the first trial registration date on 16/05/2019)

Amorphous curcumin-based hydrogels to reduce the incidence of post-surgical intrauterine adhesions.

The incidence of intrauterine adhesions (IUA) has increased with the rising utilization of intrauterine surgery. The postoperative physical barrier methods commonly used, such as balloons and other fillers, have limited effectiveness and may even cause further damage to the remaining endometrial tissue. Herein, we developed an injectable thermosensitive hydrogel using Pluronic F127/F68 as pharmaceutical excipients and curcumin as a natural active molecule. The hydrogel effectively addresses solubility and low bioavailability issues associated with curcumin. In vitro, drug release assays revealed that the amorphous curcumin hydrogel promotes dissolution and sustained release of curcumin. In vitro experiments reveal high biocompatibility of the hydrogel and its ability to enhance vascular formation while inhibiting the expression of fibrotic factor TGF-β1. To assess the effectiveness of preventing IUAs, in vivo experiments were conducted using IUA rats and compared with a class III medical device, a new-crosslinked hyaluronic acid (NCHA) gel. According to the study, curcumin hydrogel is more effective than the NCHA group in improving the regeneration of the endometrium, increasing the blood supply to the endometrium and reducing the abnormal deposition of fibrin, thus preventing IUA more effectively. This study provides a promising strategy for treating and preventing IUA.

HPV infection and vaginal microecological disorders in women with intrauterine adhesion: cross-sectional study in a Chinese population

BackgroundThe purpose of this study was to evaluate the vaginal microecology and the distribution of human papillomavirus (HPV) subtypes in patients with uterine adhesions and explore the correlation between HPV infection and vaginal microecology imbalance and the occurrence of intrauterine adhesion (IUA).MethodsA total of 479 women were enrolled in the study, including 259 in the normal group and 220 in the IUA group. Vaginal microecological and HPV analyses were performed on all participants. Significant differences between the two groups were analyzed, and Spearman correlation analysis was performed.ResultsThe incidence of IUA in patients between 31 and 40 years of age was high. The I-II degree of vaginal cleanliness in the IUA group was significantly lower than that in the normal group, and the number of III-IV degree was significantly higher than that in the normal group. Moreover, the incidences of VVC (vulvovaginal candidiasis) and vaginal disorders and infections with HPV 16 and HPV 52 subtypes were significantly higher in the IUA group than in the normal group. The incidence of high-risk HPV infection combined with vaginal disorders in the IUA group was higher than that in the normal group. Correlation analysis showed that the occurrence of IUAs was positively correlated with HPV infection and negatively correlated with PH and vaginal microecological imbalance.ConclusionThe HPV infection rate and vaginal microecology disorders affect the occurrence of IUAs. For patients with IUAs, control of the HPV infection rate and the prevention of vaginal microecological disorders should be improved.

Label-free proteomic analysis and functional analysis in patients with intrauterine adhesion

Intrauterine adhesion (IUA) is one of the principal causes of secondary infertility in women of reproductive age, which seriously affects female reproductive function and quality of life. In recent years, the incidence of IUA has been increasing year by year, but its pathological mechanism has not yet been clarified. This study intended to reveal the pathogenesis of IUA and find new therapeutic targets by analyzing the proteomic differences between intrauterine adhesion tissues and normal human endometrial tissues. In the label-free quantitative proteomics, we identified 789 up-regulated differentially expressed proteins (DEPs) and 539 down-regulated DEPs. These DEPs were further analyzed by Gene Ontology (GO) annotation and enrichment analysis, Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis to preliminarily clarify the biomarkers involved in the pathogenesis of the IUA. The DEPs were further verified by parallel reaction monitoring (PRM) to confirm the results of proteomics. Finally, 7 target proteins may be candidates for treatment and elucidating the pathophysiology of IUA. SignificanceIUA is a fertility complication, which has increasing incidence recently. Until now, only a little research paid attention to the proteomic changes of IUA. This is the first study focused on the comparative analysis of endometrial tissue between IUA patients and normal women. We found 7 key proteins that may become the potential biomarkers of IUA.

Repairing and Regenerating Injured Endometrium Methods.

Good endometrium is the prerequisite and guarantee for reproduction and maternal and child health. Endometrial injury caused by operation or non-operation can lead to menstrual irregularities, amenorrhea, abortion, infertility, and other gynecological diseases to bother women. Intrauterine adhesions (IUA) and thin endometrium are common diseases caused by abnormal repair after endometrium damage. The incidence of IUA is not low after uterine operative surgery, and the recurrence is pretty high after uterine adhesiolysis. At present, there were many methods for endometrial repair in clinic or in the laboratory, but the efficacy was different from methods to methods. They are mainly including estrogen therapy, stem cell therapy, complementary medicine therapy, and some physical barrier therapy. In order to guide the effective repair and regeneration of endometrium in clinic, this paper reviews the merit and demerit of these methods for endometrium regeneration and repair that have been proved to be effective in experiments and clinical in recent years.

Research progress in the correlation between reproductive tract microbiota and intrauterine adhesion.

Intrauterine adhesion (IUA) is caused by damage of the basal layer of endometrium, which leads to fibrosis of the endometrium and the formation of adhesion, resulting in partial or complete occlusion of the uterine cavity, abnormal menstruation, infertility or recurrent miscarriage. The prevalence of IUA in women has been increasing in recent years, and the high recurrence rate of moderate to severe IUA makes IUA treatment more challenging. Iatrogenic endometrial injury is the main cause of IUA. However, the incidence of IUA and the severity of IUA vary among patients who have received similar uterine operations, suggesting that there may be other synergistic factors in the development of IUA. There is a certain correlation between the pathogenesis and the microbiota of the gential tract. In many IUA patients, it has been observed that the probiotics such as Lactobacillus in the vagina is significant reduced, and the pathogenic bacteria such as Gardnerella and Prevotella are excessive growth. The reproductive tract microbiota can be involved in the development and progression of IUA via impacting immune function and metabolism.

To study the current status of uterine adhesions after fetal residue and the preventive effect of using estrogen and progesterone sequential therapy combined with Foley balloon.

To investigate the current status of uterine adhesions in patients with residual fetus and analyze the preventive effect of estrogen and progesterone sequential therapy combined with Foley balloon. Eighty-six patients with residual fetus were divided into control group and observation group. On the basis of the treatment plan of the control group, the observation group received estrogen and progesterone sequential therapy combined with Floey balloon treatment. Clinical efficacy, postoperative recovery status (abdominal pain duration, vaginal bleeding duration, vaginal bleeding volume, refluid time), the incidence of intrauterine adhesions, uterine hemodynamics (uterine artery systolic maximum blood flow rate [Vmax], end diastolic blood flow rate [Vmin], resistance index [RI]), and the probability of complications were evaluated. Compared with the control group, the observation group achieved higher curative effect (P < .05); the observation group had shorter duration of abdominal pain, vaginal bleeding and refluid time, and lower vaginal bleeding (P < .05); the probability of intrauterine adhesions is lower (P < .05); before treatment, there is little difference in the levels of Vmax, Vmin, RI, and other indicators between the 2 groups (P > .05). After treatment, compared with the control group, the observation group Vmax, Vmin, and other indicators, the level was significantly lower, and the RI level was significantly higher (P < .05); the observation group had a lower probability of complications (P < .05). The likelihood of uterine adhesions after fetal remains is increased. The use of estrogen and progesterone sequential therapy in conjunction with Foley balloon therapy can improve treatment efficacy, improve uterine adhesion prevention, and promote patient recovery after surgery.

Incidence and risk factors of intrauterine adhesions after myomectomy

ObjectiveTo determine the incidence and risk factors for intrauterine adhesions (IUAs) after minimally invasive and open myomectomy and hysteroscopic myomectomy (HM).DesignRetrospective cohort study.SettingUniversity-affiliated fertility center.Patient(s)Patients aged ≥18 years undergoing robotic-assisted or conventional laparoscopic minimally invasive myomectomy, abdominal myomectomy, or HM between January 2007 and January 2017. Only patients who underwent uterine cavity evaluation within 12 months of surgery via hysteroscopy or hysterosalpingography were included. Patients were excluded if they had a history of IUA before myomectomy.Intervention(s)Not applicable.Main Outcome Measure(s)The primary outcomes of this study were the presence and severity of IUA. The secondary outcomes were the identification of risk factors for IUA formation. The severity of IUAs was scored by 2 investigators using a previously published grading system by March et al.Result(s)Of 1,315 patients who underwent myomectomy, 173 (13.2%) met the inclusion criteria. Intrauterine adhesions were identified in 9.3% of all patients, 75.0% of which were classified as minimal. The incidence of IUA did not vary by modality: 8.6%, minimally invasive myomectomy; 7.8%, abdominal myomectomy; and 11.8%, HM. There were no differences in incidence of IUA by the number or size of fibroids removed. Of patients with IUA, 87.5% had submucosal fibroids resected compared with 58.6% without IUA.Conclusion(s)The incidence of postoperative IUA in women undergoing myomectomy of any modality is relatively low (9.3%) and does not vary by modality alone. Most IUAs are of minimal degree. The presence of submucosal fibroids is associated with an increased risk of IUA in all modalities.

Analysis of the etiologies of female infertility in Yunnan minority areas

BackgroundThe present study aims to provide a comparative analysis of the etiologies of female infertility between Dehong, on the Yunnan Frontier, and Kunming.MethodsA retrospective study, which included 941 infertile females in Kunming who were treated in the First People’s Hospital of Yunnan Province and infertile females who were treated in the local hospital in Dehong from January 2016 to November 2018, was conducted. A comparative analysis of the etiologies of infertility in the two regions was then carried out.ResultsIn patients with primary infertility, ovulation disorder (15.03%) was the main cause of infertility in Kunming, and pelvic inflammatory disease (25.59%) was the main cause in Dehong. With regard to secondary infertility, although pelvic inflammatory disease was the main cause of infertility in both regions, the incidence of intrauterine adhesions in Kunming was significantly higher than in Dehong.ConclusionsThe etiology of infertility showed different epidemiological characteristics depending on the region, hence individualized treatment should be given accordingly

Incidence and Risk Factors for Intrauterine Adhesions Following Myomectomy

Study Objective To determine the incidence & risk factors for intrauterine adhesions (IUA) following myomectomy. Design Retrospective cohort. Setting Academic practice. Patients or Participants 158 women undergoing robotic (RM), laparoscopic (LM), abdominal (AM) or hysteroscopic (HM) myomectomy between 2007-2017 with post-procedure hysteroscopy within 12 months of surgery were included. Women with a history of IUA were excluded. Interventions IUA's were ranked by two authors as minimal, moderate, or severe. Measurements and Main Results The most common indications for myomectomy were infertility (57%) abnormal uterine bleeding (39.9%), and pain/bulk symptoms (27.8%). The overall incidence of IUA was 10.1% (n=16), 75% of which were categorized as “minimal” and 25% as “moderate”. The incidence of IUA was highest for LM (14.3%), followed by HM (12.0%), AM (9.1%), and RM (8.8%). Women with a history of prior uterine surgery had more IUA's identified (12.5 vs 9.3%). Women with 1 fibroid removed had a similar incidence of IUA as those with 2-4 removed (8.7 vs 8.9%). Those with ≥ 5 fibroids had the highest incidence of IUA (11.9%). Women with at least 1 submucosal fibroid had an incidence of IUA of 14.6%. Those with at least 1 intramural fibroid had an incidence of 11.7%. Fibroids requiring ≥ 4 layers of closure had an IUA incidence of 14.6% compared to requiring Conclusion IUA can occur without intraoperative breech of the uterine cavity. Adenomyosis, 4-layer closure, ≥ 5 fibroids, and history of prior uterine surgery may increase risk for intrauterine adhesion formation, but larger studies are needed to definitively determine risk.

Level of depression, anxiety and stress in patients with intrauterine adhesions in Hunan Province, China: A cross-sectional study.

BackgroundThe incidence of intrauterine adhesions has been increasing in recent years, seriously affecting women’s health. This study aimed to investigate the psychological status and identify risk factors associated with high psychological distress in patients with intrauterine adhesions.MethodsA cross-sectional study was conducted in Hunan Province, China. A total of 258 patients who presented with intrauterine adhesions between February and May 2018 were included. Data were collected by a questionnaire packet that included the Depression Anxiety Stress Scale, the Medical Coping Mode Questionnaire, and demographic and clinical information. Descriptive statistics, t-tests, one-way ANOVA, Pearson’s correlations and multiple linear stepwise regression were employed in this study.ResultsAmong 258 participants, the detection rates of mild depression and moderate to extremely severe depression were 10.1% and 10.5%, respectively; the detection rates of mild anxiety and moderate to extremely severe anxiety were 11.2% and 20.2%, respectively; the detection rates of mild stress and moderate to extremely severe stress were 9.3% and 10.2%, respectively. Avoidance and resignation coping were positively correlated with the overall scores of general distress which represents the total scores of the Depression Anxiety Stress Scale (r = 0.171, 0.475, P < 0.01). Multiple linear stepwise regression results showed that husband-wife relationships and avoidance and resignation coping strategies were the main factors predicting general distress levels.ConclusionsPatients with intrauterine adhesions have psychological distress in a certain extent. Target interventions should be taken to improve the mental health level of patients.

Prevalence of intrauterine adhesions after hysteroscopic myomectomy by integrated Bigatti Shaver (IBS)

Background: Myomectomy is the best procedure for treatment of uterine fibroids. However, post-myomectomy adhesions represent a major problem. The introduction of hysteroscopic myomectomy thought to reduce these adhesions. However, the incidence is not determined after different shavers.Aim of the work: To assess the prevalence of adhesions in women undergoing IBS-myomectomy for uterine fibroids.Patients and methods: The study included 70 women indicated for IBS myomectomy. Eligible females were submitted to full history taking, clinical examination and routine laboratory investigations. In addition, all patients underwent transvaginal ultrasonography. Fibroid grade was defined and hysteroscopic myomectomy. Then office hysteroscopy was done after 3 months of the procedure, and any pathology especially intrauterine adhesions was reported. Patients were classified into two groups; with adhesions and without adhesions.Results: The incidence of adhesions was 5.7%. The development of adhesion was usually associated with multiple myomas present in posterior position who need long resection time and usually the resection is incomplete. The adhesions were usually mild [75%] and there was no complications were reported after hysteroscopic myomectomy.Conclusion: The incidence of intrauterine adhesion after the hysteroscopic myomectomy by IBS is low

The link between intrauterine adhesions and induced termination of pregnancy remains a challenge.

Termination of pregnancy (TOP) or induced TOP is one of the most commonly performed interventions on women of reproductive age: it is estimated that 30–50% of women will undergo at least one TOP during their lifetime (Templeton et al. N Engl J Med 2011;365:2198–204). Intrauterine adhesions (IUAs) are thought to develop following the destruction of the basal layer of the endometrium: during the healing process opposing walls of the uterus adhere together (Schenker Eur J Obstet Gynecol Reprod Biol 1996;65:109–13). There is a link between induced TOP and IUA, but data concerning the incidence of IUA are conflicting. Mentula and co-workers conducted a retrospective nationwide registry cohort study. The rate of IUAs in 79 960 eligible induced TOPs were assessed: 1.5 and 2.0 cases of IUA per 10 000 TOPs following medically and surgically induced TOPs, respectively. Surgical evacuation of the remaining products of conception was significantly related to the risk of IUA formation (odds ratio, OR, 5.50; 95% confidence interval, 95% CI, 1.5–20.8). Although the authors should be complemented for conducting one of the largest studies on this topic, the results should be interpreted with caution. The authors included a wide range of diagnostic and operation codes to include as many cases of IUA as possible. Nevertheless, the reported incidence should be regarded as an underestimation of the real incidence. Women were retrieved by linking TOP registry data with hospital discharge registry data. The diagnosis of IUA was based on diagnostic and operation codes. Women with IUA who were asymptomatic remained undiscovered. Furthermore, the most severe cases of IUA requiring treatment were detected. The data in the TOP registry reported only the first attempted method for TOP. The method of TOP in women who received both treatment options was only classified by the primary method. Induced TOPs from 2000 to 2008 were analysed (representing an 8-year period). The question remains whether the treatment methods were comparable during the years included. In this registry-based study, detailed information on how medical or surgical treatment was performed throughout the period of study was not available. Nevertheless, there seems to have been differences across the years, as the rate of IUA significantly differed: 10 of the 12 IUA cases (83.3%) were diagnosed in the period 2000–2003, and only two IUA cases (16.7%) were diagnosed in the period 2004–2008 (P < 0.01). Furthermore, the overall re-evacuation rates after surgical management varied significantly, ranging from 11.8% in 2000 to 4.6% in 2008 (P < 0.001). Despite the reported limitations, Mentula and co-workers must be complimented for conducting this study on a clinically relevant topic. IUA formation is multifactorial, and can result in menstrual disturbances, infertility, and miscarriage. If pregnancy occurs, the risk of fetal growth restriction and placental implantation disorders is increased (Schenker et al. Fertil Steril 1982:37;593–610). Treatment of women with IUA remains a challenge, with the prognosis of moderate and severe adhesion remaining unsatisfactory. Even after hysteroscopic adhesiolysis, reproductive performance remains unsatisfactory (March Obstet Gynecol Clin North Am 1995:22;491–505). IUA should be considered a surrogate indicator, as long-term fertility, reproductive outcome, and obstetric complications are clinically relevant. As a result of the possible implications of IUA, the prevention of IUA is crucial. None declared. The completed disclosure of interest form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

麒麟丸治疗稽留流产清宫术后患者40例

目的：研究麒麟丸对于稽留流产患者清宫术后的治疗效果。方法：选取40例稽留流产患者作为试验对象，随机分为治疗组20例和对照组20例。治疗组术后给予口服麒麟丸治疗1月，比较两组患者阴道出血时间、月经恢复时间、子宫内膜厚度以及是否存在宫腔粘连情况，用统计学方法分析两组间差异。结果：2组患者阴道流血时间无明显差异(P > 0.05)，对照组月经恢复时间明显长于实验组(P 0.05), while the menstrual recovery time of control group was significantly longer than the experimental group (P < 0.05). Moreover the endometrial thickness of treatment group was greater than that of the control Group (P < 0.05). The incidence of intrauterine adhesions in control group was higher than that of the experimental group (P < 0.05). Conclusion: After giving Qilin Pill treatment, the recovery of the menstrual cycle OF patients with missed abortion curettage can be effectively promoted, so as the endometrial recovery, and the incidence of intrauterine adhesions would be reduced, which has a positive effect on patients who need to be pregnant again.

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

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.

Intrauterine Adhesions Following Miscarriage: Look and Learn.

To examine the incidence of intrauterine adhesions (IUA) following the management of miscarriage in women with previously documented normal uterine cavities. We conducted a retrospective cohort study from two fertility clinics with standard practice protocols for evaluating the uterine cavity prior to infertility treatment and following clinical pregnancy loss. A database query and manual chart review identified 144 women with normal uterine cavities who experienced a miscarriage between January 2010 and November 2012 and returned to the clinic for follow-up hysteroscopy. Following documentation of a non-viable clinical pregnancy using transvaginal ultrasound, patients chose expectant, medical, or surgical management according to standardized clinical protocols. The primary outcome was the detection of IUA. Secondary outcomes included the presence of retained products of conception and various risk factors associated with the development of IUA. The incidence of IUA following early pregnancy loss was 6.3%. There were no significant differences in patient characteristics between those with and without IUA. There was a significant association between IUA and increasing uterine size, particularly in the presence of multiple gestation (P= 0.039). Mechanical suction dilatation and curettage (D&C) was a risk factor for IUA, but manual vacuum aspiration was not a risk factor (P= 0.003). Retained products of conception were found in 13.9% of study participants, and the incidence did not differ among management options. This appears to be the first documentation of IUA that were entirely attributable to the index miscarriage or its management. There appears to be an increased risk of IUA following D&C with larger uteri and multiple pregnancies and following mechanical suction D&C.

Effects of retained placenta and membrane patients who complete curettage of uterine cavity with the hysteroscopy when injecting oxytocin in the cervix before operation and shorting the time of single expanding uterus

Objective To investigate the effects on retained placenta and membrane patients who complete curettage of uterine cavity with the hysteroscopy when injecting oxytocin in the cervix before operation and shorting the time of single expanding uterus. Methods Totally 147 patients at the Maternal and Child Health Hospital of Hunan Province were divided into the intervention group (72 cases) and control group (75cases). The intervention group was injected 10u oxytocin in the cervix before hysteroscopy and curettage of uterine cavity, all at once, controlling the time of single expanding uterus (no more than 5 minutes). The control group was not injected oxytocin before hysteroscopy and curettage of uterine cavity, and not limited the time of single expanding uterus (5 minutes to 10 minutes). A series of parameters were compared among two groups, including total expansion uterine time, mean single expansion uterine time, operation time, frequency of hysteroscopy, the amount of bleeding, hemoglobin decline, hemostatic measures use rate, postoperative infection rate, the rate of the second time curettage, and incidence of intrauterine adhesions. Results Compared to the control group, total expansion uterine time, mean single expansion uterine time, and operation time were significantly shorter in the intervention group; at the same time, the amount of bleeding, other hemostatic measure use rate, and incidence of intrauterine adhesions were significantly less in the intervention group (P 0.05). Conclusions Not only the time of operation and the amount of bleeding are decreased but also postoperative infection rate and incidence of intrauterine adhesions are decreased when injecting oxytocin before hysteroscopy and shorting the time of single Expanding uterus. In other words, this method can keep clear vision of operation under direct vision, avoid repeated curettage, tissue trauma, decrease incidence of intrauterine adhesions, increase operative successful rate, and keep healthy and reproductive capacity of patients. Therefore, it is worth promoting. Key words: Oxytocin/AD; Hysteroscopy; Placenta, retained/SU; Dilatation and curettage

Clinical and Demographic Characteristics of Women with Intrauterine Adhesion in Abuja, Nigeria

Objective. Infertility menstrual abnormalities continue to constitute a significant bulk of gynecological consultation in Africa. Both of these problems are sometimes traced to intrauterine adhesions which are preventable in the majority of cases. Study Design. A retrospective analysis of intrauterine adhesions at the National Hospital Abuja, Nigeria, was carried out, covering the period from 1st September 1999 to 1st September 2004. A total of 72 cases were analyzed. Statical analysis was done using X 2. Results. The incidence of intrauterine adhesions was 1.73% of new patients. Mean age ± SD was 29.97 ± 4.82 years. Patients who were Para 0 to 1 constituted 81.9% of the total. Intrauterine adhesions significantly (P < 0.02) occurred in nulliparae. The majority (68%) were educated only up to secondary level which was significant (P < 0.05). Menstrual abnormalities were present in 90.3%. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation. Conclusion. Intrauterine adhesions are associated with lower educational status and low parity. Increasing educational targets nationally, poverty alleviation, nationwide retraining in manual vacuum aspiration, and wider application of this technique are recommended.

Aetiology, clinical features and treatment outcome of Intrauterine adhesion in Ilorin, Central Nigeria

Intrauterine adhesion is a cause of menstrual disorder and reproductive failure. It could be a long term sequelae of unsafe abortion which is a common reproductive health problem in developing countries. To determine the predisposing factors, mode of presentation and outcome of management of intrauterine adhesion in University of Ilorin Teaching Hospital. The record of patients with intrauterine adhesion newly diagnosed and managed in the Hospital over a five-year period was analyzed for their age, parity, predisposing factors, clinical presentation, methods of diagnosis and treatment outcome. A total of 136 patients were newly diagnosed and managed for intrauterine adhesion during the period under review. This constituted 1.3% of new gynaecological patients and 4.0% of consultations for infertility. Endometrial curettage on account of pregnancy complications accounted for 92 (67.6%) patients, and this was mostly for induced abortion. Hypomenorrhoea and secondary amenorrhoea were the commonest presenting menstrual abnormalities occurring in 48 (35.3%) and 53 (39.0%) patients respectively. Normal menstruation resumed in 99 (72.8%) patients following treatment. The incidence of intrauterine adhesion among gynaecological patients in this study is lower than those from previous reviews elsewhere in the country. However, dilatation and curettage for induced abortion still remains the commonest cause in our center. Measures to prevent unwanted pregnancy are needed and there should be increased advocacy for the use of manual vacuum aspiration for uterine evacuation procedures.

Early diagnosis of congenital and acquired intrauterine causes of abortion by post-abortion hysteroscopy

A prospective study was conducted on the incidence of intrauterine pathology after abortions diagnosed by post-abortion hysteroscopy. In 80 patients outpatient hysteroscopy was performed 8-12 weeks after a dilatation and curettage for incomplete or missed abortions. Intrauterine pathological changes were found in 40 patients. There were 10 cases of uterus subseptus/ bicornis and 7 of uterus arcuatus, 2 submucous myoma and 1 corpus polyp. Intrauterine adhesions were diagnosed in 20 patients. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after the first abortion (27.8% versus 14.9%). Post-abortion hysteroscopy is a simple and useful method for early diagnosis of congenital and acquired intrauterine pathology after abortions.