OJOG  Vol.4 No.2 , February 2014
Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: A descriptive study
ABSTRACT

Background: Intrauterine adhesion is a clinical entity that may present with subfertility. However, outcome of management depends on severity of intrauterine adhesion and type of treatment intervention employed. Objective: To evaluate clinical and investigative correlation of etiologic risk factors of intrauterine adhesion on fertility and pregnancy outcome following treatment. Patients and Methods: A 5 years prospective observational study. Treatment employed includes transvaginal blind intrauterine adhesiolysis, insertion of inert intrauterine device or inflated Foley’s catheter balloon and oestrogen therapy. Inclusion criteria are intrauterine adhesion as the only identifiable cause of infertility and post treatment follows up for at least a year. Results: Over a period of 5 years, 63 patients with mean age of 31.6 years and age range of 21 to 42 years were managed. Etiologic risk factors were dilatation and curettage 33 (52.4%), vacuum aspiration 13 (20.6%), myomectomy 11 (17.5%) and caesarean section in 6 (9.5%) patients. Of the 63 patients, 28 conceived giving a pregnancy rate of 44.4%. Nine out of the 28 patients that conceived had miscarriage, giving a miscarriage rate of 32.1%. The highest pregnancy rate and lowest miscarriage rate were recorded in the subgroup that had vacuum aspiration as their etiologic risk factor. Late pregnancy complications encountered are preterm contractions 5 (26.3%), placenta praevia 4 (21.1%), morbidly adherent placenta 5 (26.3%) and preterm delivery in 2 (10.5%) patients. Route of delivery was per vaginum in 13 (68.4%) patients and by caesarean section in 6 (31.6%) patients. Live birth rate was 89.5% (17/19 deliveries). There was no maternal mortality recorded. Conclusion: Compared to other risk factors, uterine vacuum aspiration was associated with higher fertility rate and better pregnancy outcome.


Cite this paper
Adesiyun, A. , Zayyan, M. , Eka, A. , Williams, I. and Ojabo, A. (2014) Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: A descriptive study. Open Journal of Obstetrics and Gynecology, 4, 95-99. doi: 10.4236/ojog.2014.42017.
References
[1]   Toaff, R. and Ballas, S. (1978) Traumatica hypomenorrhoea—Amenorrhoea (Asherman’s syndrome). Fertility and Sterility, 30, 379-387.

[2]   Ogedendge, O.K., Giwa-Osagie, O.F., Adedeji, O.F. and Oyeyinka, O. (1991) Intrauterine adhesions in Lagos Nigeria. Journal of Obstetrics & Gynaecology, 11, 134-136. http://dx.doi.org/10.3109/ 01443619109013538

[3]   Cates, W., Grimes, D.A. and Schultz, K.F. (2000) Abortion surveillance at CDC: Creating public health light out of political heat. American Journal of Preventive Medicine, 19, 12-17.
http://dx.doi.org/10.1016/S0749-3797(00)00168-9

[4]   Grimes, D., Schultz, K.F., Cates, W. and Tyler, C.W. (1977) The joint program for the study of abortion CDC —A preliminary report. In: Hern, W. and Andrikopolous, B., Eds., Abortion in the seventies, National Abortion Federation, New York, 41-46.

[5]   Toaff, R. (1962) Amenorrhoea hypomerrhoea traumatic (Sindrome di Asherman). Atti de la Societa Italiana di Ginecol, 49, 258.

[6]   Toaff, R. and Krochik, N. (1963) Le traitement des synechies uterines post traumatiques (syndrome d’ Asherman. Comptes Rendus de la Societe Francaise de Gynecologie, 5, 323.

[7]   March, C.M., Israel, R. and March, A.D. (1978) Hysteroscopic management of intrauterine adhesions. American Journal of Obstetrics & Gynecology, 130, 653-657.

[8]   Wamsteker, K. and DeBlok, S. (1993) Diagnostic hysteroscopy: Technique and documentation. In: Sutton, C. and Diamond, M., Eds., Endoscopic surgery for gynaecologists, Saunder, London, 263-276.

[9]   Giwa-Osagie, O.F. and Emuveyan, E.E. (1968) Evaluation of secondary amenorrhea. Nigerian Medical Practitioner, 7, 79-83.

[10]   Otubu, J.A.M. and Olanrewaju, R.S. (1989) Hysteroscopy in infertile Nigerian Women. African Journal of Medicine & Medical Sciences, 18, 117-120.

[11]   Palter, F. (2003) Poly spyrou. Asherman’s syndrome: Etiologic factors, patterns of pregnancy loss and treatment results. Results from an international registry. Fertility and Sterility, 80, 26-37. http://dx.doi.org/10.1016/S0015-0282(03)01900-9

[12]   March, C.M. and Israel, R. (1976) Intrauterine adhesions secondary to elective abortion. Hysterscopic diagnosis and management. Obstetrics & Gynecology, 48, 422-424.

[13]   Letterie, G.S. and Haggerty, M.F. (1994) Magnetic resonance imaging of intrauterine synechiae. Gynecologic and Obstetric Investigation, 37, 66-68. http://dx.doi.org/10.1159/000292525

[14]   March, C.M. (1995) Intrauterine adhesions. Obstetrics & Gynecology Clinics of North America, 22, 491-505.

[15]   Schenker, J.G. (1996) Etiology of and therapeutic approach to synechic uteri. European Journal of Obstetrics & Gynecology and Reproductive Biology, 65, 109-113. http://dx.doi.org/10.1016/0028-2243(95)02315-J

[16]   Coccia, M.E., Becattini, C., Bracco, G.L., Pampaloni, F., Bargelli, G. and Scarselli, G. (2001) Presuure lavage under ultrasound guidance: A new approach for outpatient treatment of intra-uterine adhesions. Fertility and Sterility, 75, 601-606. http://dx.doi.org/10.1016/S0015-0282(00)01770-2

[17]   Protopapas, A., Shushan, A. and Magos, A. (1998) Myometrical scoring: A new technique for the management of severe Asherman’s syndrome. Fertility and Sterility, 69, 860-864.
http://dx.doi.org/10.1016/S0015-0282(98)00036-3

[18]   Ikeda, I., Morita, A., Inamura, A. and Mori, I. (1981) The separation procedure for intrauterine adhesions (synechia uteri) under roentgenographic view. Fertility and Sterility, 36, 333-338.

[19]   Zinger, M., Thomas, M.A. and Liu, J.H. (2001) Vaginal sildenafil (Viagra) improves endometrium in Asherman’s syndrome. Fertility and Sterility, 76, 255. http://dx.doi.org/10.1016/S0015-0282(01) 02765-0

[20]   Mohammed, I.A. and Karim, H.A. (2006) Amnion graft following hysteroscopic lysis of intrauterine adhesion. Journal of Obstetrics and Gynaecology Research, 32, 559-566.
http://dx.doi.org/10.1111/j.1447-0756.2006.00454.x

[21]   Ducarme, G., Davition, C., Zarrouk, S., Uzan, M. and Poncelet, C. (2006) Interest of autocross linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery. A case controlled stydy. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 35, 691-695. http://dx.doi.org/10.1016/S0368-2315(06)76465-1

[22]   Speroff, L. and Fritz, M.A. (2005) Amenorrhoea. In: Clinical gynaecologic endocrinology and infertility, 7th Edition, Lippincott Williams and Wilkins, Philadelphia, 401-463.

[23]   Ismajovich, B., Lidos, A., Confino, E., et al. (1985) Treatment of minimal and moderate intrauterine adhesions (Asherman’s syndrome). Journal of Reproductive Medicine, 30, 769-772.

[24]   March, C.M. and Israel, R. (1981) Gestational outcome following hysteroscopic lysis of adhesions. Fertility and Sterility, 36, 455-459.

 
 
Top