Transcervical Resection Of Adhesion Research Articles

Recent Advancement in the Management of Intrauterine Adhesions Using Stem Cell Therapy: A Review Article.

Intrauterine adhesions (IUAs) are the formation of scar tissues in the endometrial cavity. The fibrous tissue in the uterus decreases the space inside the uterine cavity. It includes both endometrium and myometrium. It may lead to hypomenorrhea or amenorrhea, pain, difficulty in conceiving, and recurrent abortion. IUA is caused by uterine tissue damage mostly during surgical procedures such as dilatation and curettage. Other causes may include pregnancy-related complications, miscarriage, abnormal bleeding, infections, fibroid removal, and cesarean section (C-section). Patients generally do not have any symptoms and hence are unaware of the condition. The main therapeutic procedure presently used is hysteroscopic transcervical resection of adhesion (TCRA) with hormonal therapy and nondegradable stent as postoperative adjuvant therapy. It has some major limitations such as failure to prevent recurrence and preserve fertility along with difficulty in endometrial tissue repair due to its anatomical site. These limitations have forced the researchers to think about a better treatment modality. In recent times, a better treatment modality has evolved with stem cell therapy. Therefore, this review presents the recent and advanced therapeutic modalities for the treatment of IUAs.

Improvement of vaginal probiotics Lactobacillus crispatus on intrauterine adhesion in mice model and in clinical practice

BackgroundIntrauterine adhesion (IUA) is a frequent acquired endometrial condition, for which there is no effective preventive or treatment. Previous studies have found that vaginal microbiota dysregulation is closely related to endometrial fibrosis and IUA. Therefore, we wondered whether restoration of vaginal microbiota by vaginal administration of L. crispatus could prevent endometrial fibrosis and ameliorate IUA.ResultsFirst, we created a mechanically injured mouse model of IUA and restored the mice’s vaginal microbiota by the addition of L. crispatus convolvulus. The observations suggested that intrauterine injections of L. crispatus significantly decreased the degree of uterine fibrosis, the levels of IL-1β and TNF-α in blood, and downregulated the TGF-β1/SMADs signaling pathway in IUA mice. A therapy with L. crispatus considerably raised the abundance of the helpful bacteria Lactobacillus and Oscillospira and restored the balance of the vaginal microbiota in IUA mice, according to high-throughput sequencing. Then we conducted a randomized controlled trial to compare the therapeutic effect of L. crispatus with estrogen after transcervical resection of adhesion (TCRA). And the results showed that vaginal probiotics had a better potential to prevent intrauterine adhesion than estrogen.ConclusionsThis study confirmed that L. crispatus could restore vaginal microbiota after intrauterine surgery, inhibit endometrial fibrosis, and finally play a preventive and therapeutic role in IUA. At the same time, it is a new exploration for the treatment of gynecological diseases with vaginal probiotics.Clinical trial registration: http://www.chictr.org.cn/, identifier (ChiCTR1900022522), registration time: 15/04/2019.

Reproductive outcomes of women with moderate to severe intrauterine adhesions after transcervical resection of adhesion: A systematic review and meta-analysis.

Intrauterine adhesions (IUA) refers to the adhesion of the inner wall of the uterus, resulting in complete or partial occlusion of the uterine cavity, which causes a series of symptoms. Transcervical resection of adhesion (TCRA) is the standard surgical method for patients with IUA. However, the recurrence rate of women with moderate to severe IUA is high and it has raised a big concern about the reproductive outcomes. We conducted a scoping review by using 4 databases, including Google Scholar, PubMed, Scopus, Embase, and web of science, to retrieve relevant literature from September 1, 2001, to February 1, 2023, and to explore the reproductive outcomes in women with moderate to severe IUA after TCRA treatment. Following defined guidelines, data extraction was carried out by 2 researchers, and the findings were examined by 2 senior academics. The papers were evaluated by 2 reviewers using the inclusion and exclusion criteria. Using a form developed especially for this study, pertinent information was retrieved, including the first author, research design, study duration, age, intervention measurement, pregnancy rate, techniques of conception, and live birth rate. Two researchers conducted a quality assessment to determine any potential bias using the Cochrane technique and the Newcastle-Ottawa scale. RevMan 5.4.1 (The Cochrane Collaboration, London, United Kingdom) was used for data analysis, while I2 was used to evaluate heterogeneity. In total, this study included 2099 participants. After a detailed systematic review and meta-analyses, the results showed that pregnancy and live birth rates were increased significantly after TCRA, and the risk difference of the pregnancy rate was 1.75 [1.17, 2.62]. Besides, in 2 retrospective studies, the risk difference of live birth rate was 2.26, with a 95% confidence interval of 1.99 to 2.58. Moreover, the menstrual status of women also was improved, and the risk difference of hypermenorrhoea and amenorrhea were -0.28 [-0.37, -0.19] and -0.06 [0.26, 0.13], respectively. Taken together, TCRA is the useful strategy for the treatment of moderate to severe IUA to enhance the reproductive outcomes in women.

A comparison of special intrauterine balloons and intrauterine contraceptive devices in the treatment of intrauterine adhesions

PurposeThis study aimed to compare the efficacy of a special kind of intrauterine balloon (IUB) and that of an intrauterine contraception device (IUD) for patients with intrauterine adhesions (IUAs) after transcervical resection of adhesion (TCRA).MethodsIn this retrospective cohort study, after TCRA, 31 patients received a special IUB, and 38 patients received an IUD. The Fisher exact test, logistic regression method, Kaplan–Meier method and Cox proportional hazards regression model were used for statistical analysis. A two-sided value of P < 0.05 was considered statistically significant.ResultsThe readhesion rate significantly differed between the IUB group and IUD group, at 15.39% and 54.06%, respectively (P = 0.002). For recurrent moderate IUA, patients in the IUB group had lower scores than patients in the IUD group (P = 0.035). There was a significant difference in the intrauterine pregnancy rate of IUA patients in the IUB group and IUD group after treatment, with rates of 55.56% and 14.29%, respectively (P = 0.015).ConclusionPatients in the special IUB group had better outcomes than those in the IUD group, which has a certain guiding significance for clinical work.

The effect of the combined use of an intrauterine device and a Foley balloon in the prevention of adhesion following hysteroscopic adhesiolysis

ABSTRACT The aim of this study was to determine whether intrauterine device (IUD) combined with Foley balloon could obtain better efficacy in preventing re-adhesion for patients with intrauterine adhesions (IUAs). The data of 89 patients with IUAs, who underwent transcervical resection of adhesion (TCRA) operation, were retrospectively collected. According to the method used for preventing re-adhesion of the uterine cavity after TCRA, the enrolled patients were divided into IUD group, Foley balloon group and the combined group. The second-look hysteroscopy was carried out at 3 months after TCRA surgery. The severity and extent of IUA were scored by American Fertility Society (AFS) scoring system. The endometrial thickness (EMT) was measured by ultrasound. Furthermore, the menstruation and pregnancy outcomes were also assessed. Our results showed that the postoperative decrease in AFS score was significantly greater in the combined group than in the IUD group or in the Foley balloon group. The increase in menstrual score among the 3 groups was not significantly different. The difference between preoperative and postoperative values of EMT was greater in the combined group than in the other 2 groups. In conclusion, the effect of a Foley balloon combined with IUD in preventing re-adhesion after TCRA might be better than that of IUD or Foley balloon alone.

A novel intrauterine barrier for preventing the recurrence of IUA after TCRA procedure

Intrauterine adhesion (IUA) is the result of abnormal endometrium repair after trauma and infection that damages the basal layer of the endometrium, which is then replaced by scar tissue. In such instances, the endometrium partially or completely loses the ability to conceive the embryo. Even after surgery-based comprehensive treatment, a high rate of adhesion remains. A thin endometrium, poor blood supply, and poor function may also lead to refractory infertility, resulting in a poor reproductive prognosis even when the uterine cavity has been completely restored to normal. Therefore, two key points of postoperative management are the use of an intrauterine barrier to prevent re-adhesion and medicine to promote endometrial repair. However, there is currently no clinically applicable barrier that can meet the personalized dimensions of uterine cavity shape and size or effectively separate the wound wall. We have designed an intrauterine barrier that consists of a unique uterine-shaped, estrogen-release intrauterine device (IUD), which can be combined with an injectable, temperature-sensitive hydrogel. For this study, we will insert an estrogen-release IUD into the uterine cavity following transcervical resection of adhesion (TCRA) surgery, at the same time injecting 3–5 mL of liquid hydrogel at room temperature into the uterine cavity via the cervical channel. Due to its temperature sensitivity, the hydrogel will gradually solidify into a jellylike consistency, filling the uterine cavity with a solid barrier and completely preventing contact with the wounded wall to avoid the recurrence of adhesion. The estrogen-release IUD will be wrapped in the hydrogel barrier, which has many pores that allow sustainable estrogen release to promote endometrial regeneration and repair. This protocol can meet the needs of postoperative management of TCRA, but experimental and clinical studies are still needed to demonstrate its effectiveness. If patients in the study group have a lower adhesion recurrence and higher pregnancy rate compared to controls, our hypothesis will be confirmed that this barrier will prove a clinical application to help the functional repair of the endometrium and achieve a good reproductive prognosis.

Estradiol and intrauterine device treatment for moderate and severe intrauterine adhesions after transcervical resection

ObjectiveTo explore the effect of 4 mg/day, 6 mg/day, and 8 mg/day estradiol alone or in combination with an intrauterine device (IUD) in patients with moderate and severe intrauterine adhesion (IUA) after transcervical resection of adhesion (TCRA).MethodsPatients with moderate or severe IUA who reived 4 mg/day, 6 mg/day, and 8 mg/day estradiol alone or in combination with an intrauterine device (IUD) after TCRA in Women’s Hospital, Zhejiang University School of Medicine, from March 2014 to December 2014 were enrolled in this retrospective case–control study. In group A, 14 patients received estradiol 4 mg/day + IUD after the first operation; in group B, 29 patients (group B0) received estradiol 6 mg/day after the first operation, and 73 patients (group B1) received estradiol 6 mg/day + IUD; in group C, 14 patients received estradiol 8 mg/day + IUD after the first operation. Referring to ESGE's IUA diagnostic classification method, 72 patients had moderate adhesion, and 58 cases had severe adhesion. Outpatient follow-up was performed at 1 and 23 months and after 1 year. The postoperative menstrual improvement, uterine cavity recovery, drug side effects at two to three months, and pregnancy situation at one year were recorded.ResultsThere were no significant differences in age, BMI, and previous intrauterine operation times between the 3 groups (all p > 0.05). Compared with Group A, more patients in group C had severe IUA (p = 0.008). In addition, there were no differences in menstrual recovery, uterine cavity recovery, and pregnancy in one year between the 3 groups (p > 0.05) and between groups B0 and B1 (p > 0.05). In group B1, 51 (69.86%) patients had IUD incarceration.ConclusionThis data suggests that 4 mg/d doses of estrogen may have the same effect in improving the menstrual condition, uterine cavity morphology, and reproductive ability compared to a higher dosage (6 mg/day estrogen and 8 mg/day). In addition, the placement of IUD in the uterine cavity during TCRA may cause IUD incarceration, and the treatment results for the prevention of IUA are not better than without IUD.

Post-hysteroscopy Duration of the Cook Balloon Uterine Stent Effect on the Re-adhesion Formation.

To compare duration of Cook balloon uterine stent on re-adhesions formation, and observe its effect on serum transforming growth factor β1 (TGF-β1) and plasminogen activator inhibitor-1 (PAI-1) levels in patients with intrauterine adhesions (IUA) undergoing hysteroscopic transcervical resection of adhesion (TCRA). Randomised controlled trial. No. 215 Hospital of Shaanxi Nuclear Industry, Shaanxi Province, China, from January 2018 to January 2019. A total of 98 patients with IUA, who underwent hysteroscopic TCRA with cold scissors, were randomly divided into Group A (n=49) and Group B (n=49). Cook balloon uterine stent was placed for 37 days in Group A and 7 days in Group B. Efficacy of two groups was compared. Total effective rate in Group A was higher than that in Group B (p=0.021). After treatment, levels of serum TGF-β1 and PAI-1 in Group A were lower than those in Group B (p <0.001, and p=0.001, respectively). Recurrence rate of IUA at three months after treatment and total incidence of complications in Group A were lower than those in Group B (p=0.012, and 0.037, respectively). Pregnancy rate in the 2-year follow-up period in Group A was higher than that in Group B (p= 0.043). Placement of Cook balloon uterine stent for 37 days after hysteroscopic TCRA in patients with IUA can effectively prevent postoperative intrauterine re-adhesion, have few complications, low recurrence rate of IUA and high re-pregnancy rate, and reduce levels of serum TGF-β1 and PAI-1. Key Words: Intrauterine adhesions (IUA), Transcervical resection of adhesion (TCRA), Transforming growth factor β1 (TGF-β1), Plasminogen activator inhibitor-1 (PAI-1), Pregnancy.

Application of Bioactive Hydrogels for Functional Treatment of Intrauterine Adhesion.

Intrauterine adhesion (IUA) is a common endometrial disease and one of the main causes of infertility in women of childbearing age. Current treatment strategies, such as hysteroscopic adhesion resection, hysteroscopic transcervical resection of adhesion (TCRA), the use of local hormone drugs, and anti-adhesion scaffold implantation, do not provide a satisfactory pregnancy outcome for moderate-severe IUA, which presents a great challenge in reproductive medicine. With the development of material engineering, various bioactive and functional hydrogels have been developed using natural and synthetic biomaterials. These hydrogels are not only used as barely physical barriers but are also designed as vectors of hormone drugs, growth factors, and stem cells. These characteristics give bioactive hydrogels potentially important roles in the prevention and treatment of IUA. However, there is still no systematic review or consensus on the current advances and future research direction in this field. Herein, we review recent advances in bioactive hydrogels as physical anti-adhesion barriers, in situ drug delivery systems, and 3D cell delivery and culture systems for seeded cells in IUA treatment. In addition, current limitations and future perspectives are presented for further research guidance, which may provide a comprehensive understanding of the application of bioactive hydrogels in intrauterine adhesion treatment.

Analysis in efficacy of autologous platelet-rich fibrin in the treatment of infertility due to intrauterine adhesions

Objective To evaluate the efficacy of autologous platelet-rich fibrin (PRF) in the treatment of infertility due to intrauterine adhesion. Methods From October 2018 to October 2019, 40 patients diagnosed as intrauterine adhesion and excluded other infertility factors in Beijing Shijitan Hospital were randomly divided into PRF group and control group, with 20 cases in each group. The intervention lasted for 8 weeks. Patients in both groups underwent transcervical resection of adhesion (TCRA), and PRF was placed in the uterine cavity immediately after TCRA and 4 weeks later in the PRF group. After 8 weeks of TCRA, a second hysteroscopy was performed, and then follow-up was performed. Pregnancy rate, intrauterine adhesions score, menstruation, and endometrial thickness (EMT) were compared between two groups. Results The pregnancy rate of the PRF group was 70.00%, which was significantly higher than 20.00% of the control group (P 0.05). Conclusion The placement of PRF combined with the TCRA can improve the pregnancy rate of infertility due to intrauterine adhesion, reduce intrauterine adhesion scores, and improve clinical symptom.

Expression and Potential Role of MMP-9 in Intrauterine Adhesion.

Objective Intrauterine adhesions affect menstruation and fertility, and endometrial fibrosis is the final manifestation of IUA. MMP-9 is closely related to fibrosis. The purpose of the study was to assess the role of MMP-9 in intrauterine adhesion (IUA) in rats and patients. Methods 40 rats and 24 women were enrolled in this study. 40 rats were randomly divided into 3 groups: IUA group (n = 20), sham group (n = 10), and control group (n = 10). Rat IUA models were established by intrauterine mechanical and chemical injured. In this study, 12 patients of intrauterine adhesions were detected and underwent TCRA (transcervical resection of adhesion) surgery, and endometrial tissue specimens were obtained during operation. One month later, an office hysteroscopy procedure was performed, and endometrial tissue specimens were obtained during operation again (postoperative group). A group of 12 normal age-matched control individuals served as controls underwent hysteroscopy and endometrial sampling. We used immunohistochemistry to detect MMP-9 expressions in rats and human endometrial tissues and to detect MMP-9 protein levels by Western blotting. In addition, we detected mRNA expression levels with qRT-PCR. Results The expression of MMP-9 in the IUA rats was reduced compared with that in the sham group and Ctrl group (P < 0.05), and the expression of MMP-9 was also reduced in the IUA patients compared with that in the Ctrl group (P < 0.05). The mRNA levels of MMP-9 in the endometrium reflected similar results (P < 0.05). The MMP-9 clearly increased even in the endometrium after TCRA surgery (P < 0.05). Conclusion Our study suggests that MMP-9 may play an important role in IUA. In the future, more in-depth research should be conducted on MMP-9.

Predictive value of live birth rate based on different intrauterine adhesion evaluation systems following TCRA

ObjectiveThe aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA).MethodThis retrospective study included 128 women with IUA who desired for spontaneous conception after TCRA. All the patients were retrospectively scored by the American Fertility Society (AFS) classification, European Society of Gynecological Endoscopy (ESGE) classification, March’s classification (March), Nasr classification (Nasr) and Chinese IUA diagnosis classification criteria (Chinese). The predictive value of these evaluation systems was determined by receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).ResultsThe correlation coefficients of AFS, ESGE, March, Nasr and Chinese classification and the live birth rate were 0.313, 0.313, 0.288, 0.380, and 0.336, respectively. Among women with hypomenorrhea and amenorrhea, as well as women with no infertility, the severities determined by all five evaluation systems were correlated with live birth rate (P < 0.001). All five scoring systems were efficient to predict live birth rate. Among them, Nasr classification showed the highest AUC (0.748) with the best predictive value. Multivariate logistic regression analyses showed that Nasr classification had the highest OR (OR, 6.523; 95% CI, 2.612, 18.263). And, Nasr’s classification system also showed highest sensitivity (81.8%) and negative predictive value (96.7%) when divide the system into mild IUA vs. moderate and severe IUA.ConclusionAFS, ESGE, March, Nasr and Chinese classification were demonstrated to be capable of predicting live birth following TCRA although the predictive capacities might be limited, and Nasr classification showed the highest predictive value of live birth.

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES:This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA).METHODS:The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy.RESULTS:After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628).CONCLUSIONS:After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

Effects of early second-look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions.

To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10days after transcervical resection of adhesion (TCRA) and hysteroscopy 20days after TCRA (n=81). The control women underwent hysteroscopy 3months after TCRA (n=75). Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions.

Intramural pregnancy following transcervical resection of adhesion: a case and review literatures

An intramural pregnancy is an unusual type of ectopic pregnancy in which the gestational sac is situated in the myometrium, separate from the endometrial cavity and fallopian tubes. There are only 22 cases in the published literature via search of PubMed from 2010 to 2018. The authors report an additional rare case of ectopic pregnancy which underwent previous surgery for intrauterine adhesions (IUA) treated by laparoscopy and they summarize the current data regarding etiology, diagnosis, and management from literature.

The study on the safety and efficacy of amnion graft for preventing the recurrence of moderate to severe intrauterine adhesions

Transcervical resection of adhesion (TCRA) is the standard treatment for the intrauterine adhesions, but the recurrence of adhesions is a tough problem for the gynecologist. In addition, the therapeutic strategy after TCRA about prevention of recurrence remains controversial especially for the patients with moderate to severe intrauterine adhesions (IUAs). Hence, we designed this study to explore the safety and efficacy of fresh amnion grafts for preventing the recurrence after TCRA for patients with moderate to severe IUAs. One hundred patients with moderate to severe IUAs who presented with a history of hypomenorrhea, amenorrhea and infertility were included in the study from January 2015 to December 2017. Patients were divided into amnion group (52 patients) and chitosan group (48 patients). Fresh amnion grafts or intrauterine injections of chitosan were administered after TCRA. Transvaginal ultrasonography (TVUS) and hysteroscopy were performed at the first and third month after the operation. The surgical procedures for all patients were completed successfully without relevant complications. In amnion group, 8 patients exhibited relapse in the first month and 2 patients in three months after surgery; in chitosan group, 23 women exhibited relapse in the first month and 18 patients in three months after surgery. Statistical analysis revealed that the recurrence rate of adhesion in amnion group was significantly lower than those of chitosan group in the first and three months after surgery (P1 = 0.000, P2 = 0.000). After TCRA, fresh amnion graft plays a significant role in preventing further adhesions than injections of chitosan.

Transdermal estrogen gel and oral aspirin combination therapy improves fertility prognosis via the promotion of endometrial receptivity in moderate to severe intrauterine adhesion.

Intrauterine adhesion (IUA) is one of the most common gynecological diseases in women of reproductive age. IUA, particularlyin moderate to severe forms, accounts for a large percentage of infertility cases. Clinically, the first-line treatment strategy for IUA is transcervical resection of adhesion (TCRA), followed by adjuvant postoperative treatment. Estrogen is one of the classic chemotherapies used following TCRA and contributes to preventing re-adhesion following surgery. However, estrogen has limited effects in promoting pregnancy, which is the ultimate goal for IUA management. In the present study, a transdermal estrogen gel and oral aspirin combination therapy was used in patients with IUA following TCRA. Compared with in the control group (transdermal estrogen only therapy), the combination therapy significantly increased endometrial receptivity marker (αvβ٣ and laminin) expression in endometrium tissues. Additionally, ultrasonic examination revealed the pulsatility index and resistant index of the uterine artery were lower in the combination therapy group. Combination therapy promoted angiogenesis and prevented fibrosis following TCRA more effectively than estrogen-only therapy. Collectively, the evaluation indices, including American Fertility Society score, endometrial parameters and pregnancy rate, indicated that patients with combination therapy had better prognoses in endometrial repair and pregnancy. In conclusion, postoperative combination therapy with transdermal estrogen gel and oral aspirin may be more efficacious in enhancing endometrial receptivity by increasing uterine blood and angiogenesis, contributing to improved fertility prognosis. The findings of the present study may provide novel guidance to the clinical treatment of IUA.

Clinical analysis of hyponatremia during hysteroscopy

From November 2013 to November 2015 among 3 410 patients underwent hysteroscopy in our hospital, 14 developed hyponatremia during operation, and the incidence was 0.41%.Among 311 patients underwent hysteromyomectomy, 8 developed hyponatremia during operation, and the incidence was 2.6%.Among 476 patients underwent endometrectomy, 1 developed hyponatremia during operation, and the incidence was 0.2%.For the 8 patients underwent curettage, 62 patients underwent trans-cervical resection of adhesion and 11 patients underwent trans-cervical resection of uterine septa, the incidence of intraoperative hyponatremia was not calculated because the number of patients was less than 100.All the 14 patients with hyponatremia suffered from severe gynecological diseases or were diagnosed with a larger volume of lesion.Among the patients developing hyponatremia during hysteromyomectomy, 4 presented with large submucous myomas (maximum diameter≥3 cm), and 4 presented with medium-sized submucous myomas (1 cm≤maximum diameter≤3 cm); the maximum diameter of the intrauterine residue >2.5 cm in 2 patients, endometrial thickness was found in 1 patient, 2 patients were diagnosed with severe intrauterine adhesions, and the last one was a complete septate uterus.The duration of operation was (92±43)min, irrigation fluid deficit was 2 200(4 000)ml, and irrigation fluid pressure was 120(40) mmHg, which were higher than the level of the corresponding parameters in routine hysteroscopy.Hemodynamic instability (changes in blood pressure and heart rate >20% of the baseline value) and severe hypoxia (SpO2 95%). One patient did not develop hemodynamic instability or hypoxia.Blood natrium, potassium, chloride, calcium ion, hemoglobin and hematocrit were significantly lower during operation and on the right postoperative day than before operation (P<0.05). Blood natrium returned to normal after treatment with furosemide and/or 1%-3% sodium chloride, and no permanent neurologic damage was found in all the patients.In conclusion, hysteroscopic hyponatremia was affected by factors such as surgical type, lesion size, surgical time, irrigation fluid deficit and pressure, and the major clinical manifestations included neurological abnormalities and fluid overload. Key words: Hyponatremia; Intraoperative complications; Hysteroscopy

Expression of adhesion-related cytokines in the uterine fluid after transcervical resection of adhesion

To study the concentration of adhesion-related cytokines, transforming growth factor (TGF) β(1), platelet-derived growth factor (PDGF) BB, b-fibroblast growth factor (bFGF) in intrauterine fluid and their roles in the intrauterine-adhesion reformation. From August 2009 to February 2010, 18 patients with moderate or severe intrauterine adhesions underwent transcervical resection of intrauterine adhesion as study group, in the mean time, 20 patients with incomplete septate uterus underwent transcervical resection of septum as control group. The charge of each patient's intrauterine fluid was collected at the time of 3, 6, 9, 12, 24, 48 and 72 hours, respectively, then the concentration of the three cytokines was measured by enzyme-linked immunosorbent assay (ELISA). The concentration of the expression of TGF-β(1) in the intrauterine fluid at 3, 6, 9, 12 hours after operation in study group was (3.6 ± 0.9), (10.4 ± 1.1), (7.6 ± 1.2), (7.2 ± 1.3) ng/ml, respectively; PDGF-BB was (2.6 ± 0.6), (3.5 ± 0.5), (5.4 ± 1.0), (5.7 ± 0.8) ng/ml, respectively; bFGF was (16.9 ± 1.3), (95.8 ± 17.8), (330.9 ± 70.5), (1303.3 ± 117.4) ng/ml, respectively. The expression of TGF-β(1) in control group was (3.0 ± 0.6), (7.5 ± 0.6), (5.4 ± 0.6), (4.6 ± 0.8) ng/ml, respectively; PDGF-BB was (2.5 ± 0.4), (2.6 ± 0.5), (4.7 ± 0.6), (4.4 ± 0.4) ng/ml, respectively; bFGF was (19.1 ± 2.4), (82.9 ± 21.8), (249.0 ± 54.2), (775.6 ± 178.8) ng/ml, respectively. The concentration of TGF-β(1), PDGF-BB and bFGF reached the peak during the time of 3 - 24 hours, 6 - 48 hours, 6 - 72 hours after surgery, respectively. The concentration of TGF-β(1), PDGF-BB and bFGF in study group were significantly higher than that in control group (P < 0.05). Concentration of TGF-β(1), PDGF-BB and bFGF was positively associated with area of transcervical resection of intrauterine adhesion, those cytokines might be involved in reformatin of intrauterine-adhesion.

Interventional ultrasound diagnosis and treatment for intrauterine adhesion

Objective: The aim of this study was to discuss the method of interventional ultrasound diagnosis and treatment for intrauterine adhesion. Methods: From 1995 to 2002, 94 patients evaluated for infertility, amenorrhea, and periodic abdominal pain underwent interventional ultrasonographic examination, and all patients underwent transcervical resection of adhesion (TCRA) under ultrasound guidance. Results: 93 patients (98.94%) were diagnosed with interuterine adhesion by interventional ultrasound. 91 of 94 patients successfully underwent operative hysteroscopy. In the remaining 3 patients, uteri were perforated. The study followed 69 women treated by TCRA. The symptoms were relieved or improved in 48 patients; 4 of them were later on pregnant and 2 women with normal delivery. The intrauterine device, residual fetal bone, and gestational sac in 19 patients were removed after TCRA. The uterine cavity relapsed into adhesion in 3 patients; 2 of them underwent hysterectomy, which diagnosed adenomyosis, and another one is being followed up. Conclusions: Our study showed that interventional ultrasonography is an effective method in diagnosing and treating intrauterine adhesion.