Comparison of therapeutic efficacy of three methods to prevent re-adhesion after hysteroscopic intrauterine adhesion separation: a parallel, randomized and single-center trial

Abstract

Background: This research aims to study the efficacy of an integrated approach to prevent and treat the recurrence of intrauterine adhesions (IUA) after hysteroscopic adhesiolysis.Methods: A total of 96 patients diagnosed with moderate-to-severe intrauterine adhesions (IUA) in Nantong Maternal and Child Health Hospital from January 2016 to December 2019 were included in this parallel, randomized and single-center trial. Moderate (48 cases) and severe (48 cases) patients were randomly divided into three groups by a computer random generator: Group A (IUD, n=16), Group B, (Foley1w+IUD, n=16) and Group C (Foley1m+IUD, n=16). All patients received sequential treatment of estrogen and progesterone on the day of operation. Follow-up was performed at 1 and 3 months after treatment of uterine cavity, endometrial thickness, menstruation and pregnancy. Surgeons who performed the second-look and third-look hysteroscopy and postsurgical assessors were blinded to the randomization.Results: In total, 96 patients (48 cases in each degree) were included in the final analysis, with 16 cases in each group. No cases were lost to follow up. The primary outcome measure was AFS score, which was significantly lower in Group C than that of women in group A and Group B at 1 month (P<0.05). Similar results were observed at 3-month follow up. In patients with moderate adhesions, the pregnancy rate in Group C (Foley1m+IUD) was higher than that in Group A and Group B (P<0.05). However, in patients with severe adhesions, there was no significant difference in the pregnancy rate among the three groups (P>0.05).There was no statistical significance in infection indicators among the three groups of moderate and severe patients (P>0.05). Postoperative complications such as uterine perforation, severe bleeding, water poisoning and intrauterine infection were not observed. Conclusions:The effect of a Foley intrauterine balloon combined with IUD in preventing re-adhesion was better than that of an IUD alone. For patients with moderate adhesion, the prolongation of placement time could prevent intrauterine re-adhesion and significantly improve the pregnancy rate with strong safety.However, for patients with severe adhesions, the prolongation of intrauterine Foley balloon placement did not better prevent intrauterine re-adhesions, improve menstruation, or improve pregnancy rates.

Pregnancy Patterns Impact Live Birth Rate for Patients With Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Retrospective Cohort Study

“…A study found that AFS score has predictive value for post-operative live birth in patients with IUA ( Cao et al, 2021 ). For patients with moderate adhesion, the lower the AFS score, the higher the post-operative pregnancy rate ( Zhang et al, 2021b ).…”

The Role of Special Intrauterine Balloon and Intrauterine Contraceptive Device after TCRA in the Treatment of Intrauterine Adhesions

“…Randomized controlled trials(RCT) found that for patients who placed IUD after TCRA, the overall conception rate and live birth rate were 27.5%-47.2% and 20.0%-28.0%, respectively [4,8,9], the reformation rate was 35.0%-43.1% [9,10]. It was reported that 62.7% of IUA patients returned to normal menstruation by this way [1].…”

“…The treatment of Asherman syndrome aims to restore the anatomy and volume of uterine cavity, in the meantime, improves symptoms of different clinical presentations, and most importantly, to prevent the reformation of IUA and repair endometrium. Transcervical resection of adhesion(TCRA) by hysteroscopy is the routine operation for IUA, however, studies showed that the recurrent rate after TCRA reach up to 48.0%-62.5%, and the pregnancy rate is only 22.5%-33.3% [3,4]. Therefore, taking measures to prevent readhesion and promote endometrial regeneration and repair endometrium is absolutely crucial.…”

Applications of Hydrogels in Premature Ovarian Failure and Intrauterine Adhesion

“…Oral administration of 9 mg/diet estrogen before TCRA and 10 mg/ diet after TCRA improved pregnancy rates and menstrual cycles in patients with moderate or severe IUA (Liu AZ et al, 2016); however, estrogen therapy may increase the risk of cancer (Rossouw et al, 2002) and venous thrombosis (Bracamonte and Miller, 2001). Balloon dilatation after TCRA and early second-look hysteroscopy improved pregnancy outcomes (Sun et al, 2020), and the appropriate delay of balloon placement in the uterine cavity prevented re-adhesion but was not effective in severe IUA (Zhang et al, 2021a). The dilated balloon is a nonvariable sphere that is not able to be plasticized according to the shape of the uterine cavity, resulting in ineffective improvement of adhesions in the uterine horns (Sun et al, 2020).…”