Second-look Hysteroscopy Research Articles

Anti-adhesion barrier gels following operative hysteroscopy for treating female infertility: a systematic review and meta-analysis.

The aim of this study was to assess the effects of any anti-adhesion barrier gel used after operative hysteroscopy for treating infertility associated with uterine cavity abnormalities. Gynecologists might use any barrier gel following operative hysteroscopy in infertile women for decreasing de novo adhesion formation; the use of any barrier gel is associated with less severe de novo adhesions and lower mean adhesion scores. Nevertheless, infertile women should be counseled that there is at the present no evidence for higher live birth or pregnancy rates. There is a lack of data for the outcome miscarriage. Preclinical studies suggest that the use of biodegradable surgical barriers may decrease postsurgical adhesion formation. Observational studies in the human report conflicting results. We searched the Cochrane Menstrual Disorders and Subfertility Specialized Register (10 April 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 1), MEDLINE (1950 to 4 April 2013), EMBASE (1974 to 4 April 2013), and other electronic databases of trials including trial registers, sources of unpublished literature, and reference lists. We handsearched the Journal of Minimally Invasive Gynecology (from 1 January 1992 to 13 April 2013); we also contacted experts in the field. We included the randomized comparisons between any anti-adhesion barrier gel versus another barrier gel, placebo, or no adjunctive therapy following operative hysteroscopy. Primary outcomes were live birth rates and de novo adhesion formation at second-look hysteroscopy. Secondary outcomes were pregnancy and miscarriage rates, mean adhesion scores, and severity of adhesions at second-look hysteroscopy. Two authors independently assessed eligible studies for inclusion and risk of bias, and extracted data. We contacted primary study authors for additional information or other clarification. Five trials met the inclusion criteria. There is no evidence for an effect favoring the use of any barrier gel following operative hysteroscopy for the key outcomes of live birth or clinical pregnancy (risk ratio (RR) 3.0, 95 % confidence interval (CI) 0.35 to 26, P = 0.32, one study, 30 women, very low quality evidence); there were no data on the outcome miscarriage. The use of any gel following operative hysteroscopy decreases the incidence of de novo adhesions at second-look hysteroscopy at 1 to 3 months (RR 0.65, 95 % CI 0.45 to 0.93, P = 0.02, five studies, 372 women, very low quality evidence). The number needed to treat to benefit is 9 (95 % CI 5 to 33). The use of auto-cross-linked hyaluronic acid gel in women undergoing operative hysteroscopy for fibroids, endometrial polyps, or uterine septa is associated with a lower mean adhesion score at second-look hysteroscopy at 3 months (mean difference (MD) −1.44, 95 % CI −1.83 to −1.05, P < 0.00001, one study, 24 women; this benefit is even larger in women undergoing operative hysteroscopy for intrauterine adhesions(MD −3.30, 95 % CI −3.43 to −3.17, P < 0.00001, one study, 19 women). After using any gel following operative hysteroscopy, there are more American Fertility Society 1988 stage I (mild) adhesions (RR 2.81, 95 % CI 1.13 to 7.01, P = 0.03, four studies, 79 women). The number needed to treat to benefit is 2 (95 % CI 1 to 4). Similarly there are less’ moderate or severe adhesions’ at second-look hysteroscopy (RR 0.25, 95 % CI 0.10 to 0.67, P = 0.006, four studies, 79 women). The number needed to treat to benefit is 2 (95 % CI 1 to 4) (all very low quality evidence). There are some concerns for the non-methodological quality. Only two trials included infertile women; in the remaining three studies, it is not clear whether and how many participants suffered from infertility. Therefore, the applicability of the findings of the included studies to the target population under study should be questioned. Moreover, only one small trial studied the effects of anti-adhesion barrier gels for the key outcome of pregnancy; the length of follow-up was, however, not specified. More well-designed and adequately powered randomized studies are needed to assess whether the use of any anti-adhesion gel affects the key reproductive outcomes in a target population of infertile women.

Effectiveness of estrogen in the prevention of intrauterine adhesions after hysteroscopic septal resection: A prospective, randomized study

The aim of this prospective randomized study was to evaluate the efficacy of estrogen in preventing intrauterine adhesions following hysteroscopic septal resection and to investigate its effect on reproductive outcome. After hysteroscopic septal resection, 90 women received either estrogen or placebo (n=45 per group) for 30 days. A second-look hysteroscopy was performed after 2 months. All pregnancies occurring during the study period were recorded. Adhesions developed in three of 43 (6.9%) patients in the control group compared to none in the estrogen group. This difference was not statistically significant (P=0.24). Regarding reproductive outcome, the differences between the two groups were also not significant. Estrogen treatment was not found to prevent intrauterine adhesions or improve reproductive outcome after hysteroscopic septal resection.

Diagnostic accuracy of three-dimensional sonohysterography compared with office hysteroscopy and its interrater/intrarater agreement in uterine cavity assessment after hysteroscopic metroplasty

To compare the diagnostic accuracy of three-dimensional sonohysterography (3D-SIS) and office hysteroscopy in uterine cavity assessment after hysteroscopic metroplasty (HM) and determine the interrater/intrarater agreement for 3D-SIS. Prospective observational study. University hospital, private hospital, and clinic. One hundred forty-one women undergoing HM for septate uterus with a history of miscarriage and/or infertility. 3D-SIS and office hysteroscopy at 6-8 weeks after HM. Shape of the uterine cavity, length of the fundal notch (≥1 or <1 cm), and the presence of intrauterine adhesions were assessed, and the interrater/intrarater agreement of 3D-SIS was evaluated in 30 randomly selected patients. Uterine abnormalities were detected with the use of hysteroscopy in 18 (12.8%) of 141 women. 3D-SIS was highly accurate (97.2%), sensitive (97%), and specific (100%), with a positive predictive value of 100% and a negative predictive value of 85%. The diagnostic values of hysteroscopy and 3D-SIS were not significantly different (McNemar test). 3D-SIS showed substantial interrater/intrarater agreement regarding overall uterine cavity evaluation (κ = 0.79 and 0.78, respectively). 3D-SIS demonstrated substantial interrater/intrarater agreement for the postoperative evaluation of the uterine cavity, being as diagnostically accurate as hysteroscopy. The use of second-look hysteroscopy may be limited to cases that require reoperation.

An Alternative Approach for Removal of Placental Remnants: Hysteroscopic Morcellation

Study ObjectiveTo evaluate our initial experience with hysteroscopic morcellation for removal of placental remnants. DesignRetrospective case series (Canadian Task Force classification II-3). SettingUniversity hospital and 2 teaching hospitals. PatientsWomen with histologic confirmation of placental remnants after miscarriage, termination of pregnancy, or delivery. InterventionFrom January 2005 to May 2010, hysteroscopic morcellation was used for removal of placental remnants. Retrospective review of medical records was performed. Measurements and Main ResultsAnalysis of 105 procedures was performed. In 99 procedures (94.3%), placental remnants were removed successfully at the first approach, and 90 procedures (85.7%) were without any adverse events. In 6 patients (5.7%), uterine perforation occurred, in 4 during cervical dilation and in 2 during the hysteroscopic procedure. Postoperatively, 3 patients had fever, 1 had hemorrhage, and 1 had abdominal pain. Routine second-look hysteroscopy in 23 patients revealed mild intrauterine adhesions in 1 patient (4.4%). ConclusionHysteroscopic morcellation seems to be an effective technique for management of placental remnants. Future studies comparing various surgical treatment methods are needed to define factors that influence the ability to obtain the safest and most complete removal of placental remnants because this remains a challenging pregnancy-related condition.

A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

ObjectiveTo compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome. Study designRetrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system. ResultsBoth the intrauterine balloon group and the IUD group achieved significantly (P<0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P<0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups. ConclusionThe insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.

Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration

Study ObjectiveTo predict the 1-step complete resection rate after transrectal ultrasound-guided hysteroscopic myomectomy and to determine the usefulness of intraoperative transrectal ultrasonography (TRUS) in monitoring hysteroscopic electroresection of submucosal myomas. DesignProspective cohort study (Canadian Task Force classification II-1). SettingUniversity hospital. PatientsOne hundred twenty women with symptomatic (abnormal uterine bleeding or reproductive disorder), single, submucosal myomas underwent hysteroscopic electroresection. Groups 1 and 2 were monitored, respectively, with or without TRUS. Anatomical inclusion criteria were myoma ≤5 cm and myometrial free margin ≥3 mm above the myoma. InterventionsMyomas were evaluated preoperatively via sonohysterograpy and were graded according to the guidelines outlined by the European Society of Hysteroscopy (ESH), including size and myometrial free margin, and according to the STEPW (size, topography, extension, penetration, and lateral wall) classification. On the basis of sonographic findings, patients with myomas >3 cm received gonadotropin-releasing hormone therapy for 1 to 3 months. Hysteroscopic myomectomy was performed with or without TRUS guidance. At 4 to 8 weeks after the initial procedure, postoperative transvaginal ultrasonography, sonohysterography, or second-look hysteroscopy was performed. Measurements and Main ResultsIn the TRUS group, a significantly higher percentage of 1-step complete resections was observed than in the group without TRUS (91% vs 73%) (p = .02). This was associated with a statistically significant difference in the subgroups of myomas that were deeply penetrating into the myometrium (89% vs 55%) (p < .01). One-way logistic analysis of data for all treated patients indicated the use of TRUS, as well as the ESH and STEPW classifications, as significant factors influencing the 1-step complete resection. At multivariable logistic regression analysis, use of TRUS (odds ratio [OR], 2.74; p < .001), myomas graded 0 or 1 according to ESH (OR, 3.55; p < .001), and size <3 cm (OR, 2.35; p < .05) were significantly associated with 1-step complete resection (area under the curve, 0.80; p < .001). In the TRUS group there were two significant predictors: size <3 cm (OR = 5.21; p < .05) and myometrial free margin <5 mm (OR, 0.18; p < .05). ConclusionIntraoperative use of TRUS during hysteroscopic myomectomy increases the chance of complete 1-step removal of submucosal myomas that deeply penetrate the myometrium.

Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.

Reproduction after myomectomy: Comparison of patients with and without second-look laparoscopy

Myomectomy is associated with a high risk of de-novo adhesion formation that may decrease fertility. The purpose of this study was to compare the reproductive outcome of patients after laparoscopic or open myomectomy who underwent second-look (SL) hysteroscopy and laparoscopy including adhesiolysis with patients with no SL intervention. A total of 170 patients underwent open or laparoscopic myomectomy at one centre. All patients were recommended SL. Reproductive results were analyzed in 12 and 24 months intervals following myomectomy. Out of 170 post-myomectomy patients 96 signed informed consent with SL (group A) and 74 withheld (group B). The cumulative pregnancy rate in the 24-months follow-up was: 61.4% and 66.7% (p = 0.535) in group A and group B respectively. Adhesions of adnexa were observed and lysed in the overall of 34.0% of patients at the time of SL. Intrauterine synechiae were present in 1.56% of patients at the SL hysteroscopy. No case of uterine rupture during pregnancy or delivery was recorded. Our results show that the pregnancy rate of patients after myomectomy who underwent SL hysteroscopy and laparoscopy is similar to that of patients with no SL procedure. Adhesiolysis performed during SL does not seem to improve the reproductive outcome of post-myomectomy patients.

Operative Hysteroscopy to Remove Retained Products of Conception: Novel Treatment of an Old Problem

Study Objective To assess the efficacy and reproductive outcome of hysteroscopic removal of retained products of conception. Design Retrospective analysis (Canadian Task Force classification II-3). Setting Tertiary care university hospital. Patients One hundred fifty-nine patients were consecutively admitted to our department from July 2001 through August 2007 with a diagnosis of retained products of conception after medical abortion, dilation and evacuation, or delivery. Interventions Hysteroscopic removal of retained products of conception without the use of electrical energy. Measurements and Main Results Complete evacuation of the uterus was achieved in all patients. Trophoblastic tissue was histologically confirmed in 88%. All of the women regained normal menstrual bleeding. Complications occurred in 3 patients during or immediately after the procedure: pulmonary edema, sepsis and diffuse intravascular coagulopathy, and excessive bleeding, respectively. Of the 28 women who expressed a desire to become pregnant, 23 conceived. The conception rate was 82% (23 of 28), with a live-birth rate of 75% (21 of 28). Second-look hysteroscopy performed in 21 patients revealed no adhesions. Conclusion Hysteroscopic removal of retained products of conception is a simple and safe, and most probably the preferred procedure. It should be considered an alternative to conventional blinde evacuation by curettage. It seems that this procedure preserves the integrity of the uterine cavity while averting additional trauma, and retains reproductive capacity. Further studies, including randomized controlled trials, may be necessary to confirm these results.

Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization

Objectives To assess the efficacy of antitubercular treatment on the uterine cavity in infertile women diagnosed with genital tuberculosis using second-look hysteroscopy. Methods A total of 70 women with genital tuberculosis who underwent second-look hysteroscopy were enrolled in the study. They were started on antitubercular drugs and followed up after 6 months of therapy with second-look hysteroscopy. McNemar's χ 2 test was used to compare the hysteroscopy findings before and after antitubercular treatment. Results Antitubercular treatment improved hysteroscopy findings in women with thin or flimsy adhesions (grade I), singular dense adhesions (grade II), and occluding adhesions at the internal os (grade IIa) ( P < 0.01). Patients with extensive adhesions, extensive endometrial scarring, fibrosis, and a tubular cavity showed no improvement after antitubercular treatment. Mean endometrial thickness of the 70 patients on day 21 prior to starting drug therapy was 6.8 mm, which increased to 8.1 mm after 6 months of treatment. Conclusion Considering the exorbitant cost of assisted reproductive technology in low-resource countries, it is necessary to consider reassessment of the uterine cavity prior to beginning such treatment.

New Outpatient Subclassification System for American Fertility Society Classes V and VI Uterine Anomalies

Study Objective To produce and validate a simple, systematic and reproducible subclassification system for uterine anomalies previously classified by the American Ferility Society as Class V and VI to achieve a precise definition of each uterine anomaly, confirm the feasibility and safety of surgical correction of the anomalies, determine the type of hysteroscopic treatment, and provide a standard by which patient selection, treatment, and reproductive outcomes can be compared between centers. Design Descriptive study (Canadian Task Force Classification III). Setting Department of obstetrics and gynecology of a private clinic (hospital). Patients Eighty-nine patients undergoing office hysteroscopy to assess partial or complete “double” uterine cavity. Interventions All patients underwent 3-dimensional ultrasound. Data from hysteroscopy and untrasonography were combined to produce a geometric model comprising uterine septum length (Z variable) and fundus depth (Y variable) through which a new subclassification of the uterine anomalies was elaborated. Measurement and Main Results One patient with a bicornuate uterus detected at ultrasonography was excluded from the study. The remaining 88 patients were classified according to our subclassification system. Seventy-three patients categorized as having Z 2 cm or greater (septum intersecting one-third of the uterine cavity or more) and Y more than 0 cm (normal or straight uterine fundus) underwent resectoscopic metroplasty without laparoscopic control. Twelve patients categorized as A1 (normal uterine fundus and septum ≤0.5 cm) underwent office metroplasty. Two patients categorized as B1 (straight fundus and septum ≤0.5 cm) and 1 categorized as C1 (concave fundus and septum ≤0.5 cm) were not considered candidates for surgery. Second-look hysteroscopy confirmed complete removal of the septum in the 12 patients who underwent office metroplasty (100%) and in 70 of 73 patients (96%) who underwent resectoscopic metroplasty. Comparison of these data with data retrospectively obtained in 596 women who had undergone traditional resectoscopic metroplasty under laparoscopic control did not demonstrate any significant difference in success and complication rates. Conclusion Our outpatient subclassification system may address a precise diagnosis and a thorough categorization of patients with a partial or complete double uterine cavity, enabling safe and effective metroplasty without use of laparoscopy.

Hysteroscopic Management of Residual Trophoblastic Tissue and Reproductive Outcome: A Pilot Study

We report on the feasibility, efficiency, and reproductive outcomes of hysteroscopic resection of late residual trophoblastic tissue in 50 patients in an observational study over 6 years. Complete evacuation of the uterus was achieved in all patients by hysteroscopy. The median operative time was 21 (15-30) min. Only one surgical complication was registered: a uterine perforation in a patient with previous metroplasty. Hysteroscopic resection of persistent trophoblastic tissue seems to be a safe and efficient procedure that could be proposed as an alternative to conventional non-selective blind curettage. We would also recommend systematic second-look hysteroscopy to asess the exact prevalence of post-procedure intrauterine adhesions.

Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome

To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure. The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman's syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman's syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta. Hysteroscopic adhesiolysis for Asherman's syndrome is a safe and effective method of choice for restoring menstrual function and fertility.

Laparoscopic Strassman’s metroplasty for bicornuate uterus

The authors report the case of a 28-year-old nulliparous woman with a bicornuate uterus and one previous second trimester pregnancy loss, in whom investigations for other probable causes of abortion like genetic, infective, hormonal, and immunological were negative. A laparoscopic metroplasty was performed by Strassman’s method. Second-look hysteroscopy and laparoscopy, which was performed 7 months later, revealed a single uniform cavity with a median muscular ridge, which resembled an arcuate uterus. Pelvic adhesions were noted between the small bowel, omentum, and posterior wall of the uterus, along with pelvic endometriosis and a chocolate cyst of the left ovary. Adhesiolysis, cyst excision, and fulgration of endometriotic deposits were carried out, which were followed by the application of an adhesion barrier.

Hysteroscopic unification of a complete obstructing uterine septum: case report and review of the literature

To report a case of complete obstructing uterine septum repaired in a minimally invasive manner by operative hysteroscopy under laparoscopic guidance. A complete obstructing uterine septum is a rare congenital abnormality. To date, management of such abnormalities has traditionally been by metroplasty. Case report and review of the literature. Pediatric and adolescent gynecology service at a tertiary care hospital. A 16-year-old nulligravid presented with severe, persistent dysmenorrhea and a history of significant endometriosis. Imaging initially suggested a functional, noncommunicating uterine horn, but magnetic resonance imaging review confirmed a complete obstructing septate uterus. The patient was managed by menstrual suppression until the time of surgery. The septum was resected by operative hysteroscopy under laparoscopic guidance. The procedure was without complication. The patient recovered well and resumed spontaneous menses without dysmenorrhea. A second-look hysteroscopy 4 months later confirmed patency of the previously obstructed side and allowed the opportunity to complete the resection of the septum. Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum. Hysteroscopy is less invasive than traditional metroplasty and is associated with easier recovery. Additionally, there is no uterine scar and thus less implication for future fertility. Further series of such procedures are required to offer greater experience and proof of safety of this approach.

Hysteroscopic resection of retained placental tissue: a feasibility study

Retained placental tissue (RPT) is a serious cause of secondary postpartum haemorrhage. Various surgical therapies are available with a variety of complications and disadvantages such as uterine perforation, blood transfusions, persisting RPT, recurrence in subsequent pregnancies or Asherman’s syndrome. We describe 10 women who underwent hysteroscopic visualisation and resection of RPT. No complications occurred. RPT was histologically confirmed in 90%. No adhesions during a second-look hysteroscopy were seen. All women regained normal menstrual bleedings. Hysteroscopic selective resection of RPT should be considered in patients with secondary postpartum haemorrhage.

Early second-look flexible hysteroscopy is effective for the treatment of asherman's syndrome

Early second-look flexible hysteroscopy is effective for the treatment of asherman's syndrome

Successful pregnancy outcome with the use of in vitro fertilization after Essure® hysteroscopic sterilization

To assess the compatibility of pregnancy after IVF and ET procedures with the presence of the Essure microinsert. Prospective, single-arm, clinical study (Canadian Task Force classification III). Clinical research center. Two women requesting IVF and ET procedures after Essure microinsert sterilization. Hysteroscopic sterilization, followed by IVF and ET procedures. Successful implantation and pregnancy outcomes after IVF procedures. Both patients underwent a second-look hysteroscopy within 3 months of an IVF procedure. Device encapsulation by tissue ingrowth reduced the average number of coils trailing into the uterine cavity from four to one, with no evidence of inflammation or any other abnormality. One woman conceived in her second IVF cycle after the transfer of two embryos, and the second woman conceived in her first cycle after the transfer of 1 embryo. Ultrasound showed that the proximal echogenic segments of the microinserts remained > or =10 mm distant from the pregnancy sac. Both women had spontaneous vaginal deliveries of healthy female infants. Postpartum ultrasound demonstrated that the microinserts maintained their prepregnancy utero-tubal locations. The Essure microinsert used for hysteroscopic sterilization may be compatible with implantation and successful pregnancy outcomes after IVF.

Tissue encapsulation of the proximal Essure micro-insert from the uterine cavity following hysteroscopic sterilization

Study objective To assess the interaction between the trailing ends of a sterilization micro-insert extending into the uterine cavity and the surrounding uterine tissue environment over time. Design Multicenter, retrospective observational study (Canadian Task Force classification II-1). Setting Hospital-based clinical research centers. Patients A subset of a study population of 545 women who had undergone a hysteroscopic sterilization procedure. Intervention A second-look hysteroscopy was performed in 22 (20 with uterine bleeding, 2 pre IVF) of these 545 women between 4 and 43 months from the sterilization procedure. Measurements and main results Over a mean time period of 19.73 months, the trailing coils of the micro-inserts into the uterine cavity shortened from a mean of 5.7 mm to 2.0 mm and from 5.4 mm to 1.8 mm on the right and left sides, respectively. In cases observed within 12 months or fewer post-procedure, the complete tissue encapsulation of both micro-inserts had already occurred in 17% of the observations. Among cases evaluated from 13 to 43 months post-procedure, 25% evidenced complete encapsulation. Conclusion Two mechanisms appear to be responsible for this process. First, there is an initial mechanical “winding-in” of the micro-insert of approximately 1 rotation of its outer coil, accounting for 1 mm of its length, after release from its delivery system. Second, the tissue around the ostium appears to use the trailing coils of the micro-insert as a scaffolding structure, gradually encapsulating and excluding them from the uterine cavity. The gradual tissue exclusion of the micro-insert from the uterine cavity may make it pregnancy-compatible after in vitro fertilization and embryo transfer procedures.

Novel Adjunctive Treatment for Cervical Adhesion with Cross-Type Nelaton Catheter: A Preliminary Report and Literature Review

Intrauterine adhesion remains a common complication post dilatation and curettage (D&C) in reproductive females. Internal cervical orifice adhesion (ICA) is also observed incidentally after D&C. Here, we introduce a novel adjunctive management for ICA with cross-type nelaton catheter. In this study, 20 patients suffering from amenorrhea and ICA after D&C were included. All individuals underwent flexible hysteroscopy to confirm their simple ICA statuses. All women accepted the insertion of simple cross-type nelaton catheter. Two weeks post insertion, the catheter was removed and a second-look hysteroscopy was performed. Three months post catheter removal, the menstruation statuses and the efficiency of nelaton catheter in preventing ICA were evaluated. Nineteen patients had 3-month follow-up. Seventeen individuals (89.4%) had normal menstruation flow as well as the impact internal orifice of cervical canal. Only two patients (10.5%) had hypomenorrhea and fibrotic narrowing of the internal orifice of the cervix, which required resectoscopy to remove the internal cervical adhesions. All patients appeared the competence of endurance for these procedures. The novel cross-type nelaton catheter is a simple, well tolerated, and highly effective method for the management of ICA after D&C.