Intrauterine Use of Autologous Platelet-Rich Plasma in Management of Asherman Syndrome: A Randomized Controlled Trial

Abstract

Background: Operative hysteroscopy with lysis of intrauterine adhesions is a viable treatment option for Asherman syndrome. However, with all forms of adhesion resection, there is a high rate of reformation of intrauterine adhesions. The current study will focus on a unique technique to evaluate the use of platelet rich plasma over an inflated balloon versus conventional method (inflated balloon). Aim: This study aim to assess the efficacy of the platelet rich plasma in preventing reformation of intrauterine adhesions after adhesiolysis in cases of Asherman syndrome. Materials and Methods: This study was conducted in Ain-Shams Maternity Hospital (Early Cancer Detection and Endoscopy Unit) during the period between July 2019 and February 2020. Forty patients seeking for conception with a history of primary or secondary infertility with severe intrauterine adhesions; 20 patients (case) injected with PRP and 20 patients (control) with IU balloon. Results: Our study showed a significant increase of menses duration among the PRP group post-operative (3.0±1.1) days and preoperative menses duration (1.5±1.4) days compared to balloon post-operative (1.9±1.6) and preoperative (1.5±1.6) days. The study also showed significant increase of menses amount among the PRP group post-operative (5.2±3.7) pads, and preoperative menses duration (1.0±1.0) pads compared to balloon post-operative (2.9±3.2) and preoperative (0.9±0.9) pads. Conclusion:Platelet rich plasma after operative hysteroscopy has high efficacy and safety in improvement of menses duration, amount and adhesion score in cases suffering from severe intrauterine adhesions and decreasing postoperative adhesions.

Clinical evaluation of autologous platelet-rich plasma therapy for intrauterine adhesions: a systematic review and meta-analysis

“…Of the six RCT studies (13,(18)(19)(20)(21)25), those with appropriate randomization methods had a low risk of process bias in randomization. One study (18) had a high risk of bias for deviations from the intended interventions because the patients knew which intervention they received during the trial.…”

“…The effects of platelet-rich plasma (PRP) on changes in menstrual flow and duration were reported in three trials (19)(20)(21) involving a total of 259 participants. The results indicated that PRP administration led to an increase in menstrual flow (WMD = 2.96, 95% CI = 2.30-3.61; P < 0.001; I 2 = 0.0%) and days of menstruation (WMD = 1.13, 95% CI = 0.86-1.41; P < 0.001; I 2 = 0.0%) (Figure 3).…”

El plasma rico en plaquetas como una estrategia prometedora para el tratamiento del síndrome de Asherman

“…El manejo actual del síndrome de Asherman se enfoca en eliminar las adherencias, prevenir la recurrencia y proporcionar factores estimulantes locales para regenerar el tejido sano (Naghshineh et al, 2023) (Lusine Aghajanova et al, 2021). La lisis histeroscópica de las adherencias ha sido el tratamiento realizado por años, sin embargo, ha demostrado altas tasas de recidiva (3,1% y 23,5%,) sobre todo en adherencias graves que requieren sesiones repetidas en intervalos cortos de tiempo (Sameh et al, 2020). Las terapias actuales son variadas, algunas emplean estrógenos exógenos, vitamina E, L-arginina, citrato de sildenafilo vía vaginal, pentoxifilina y aspirina, todas ellas con éxito limitado.…”

“…Se utiliza desde 1980, después de un proceso de extracción y centrifugación de la sangre total, obteniendo un concentrado de 1.000.000 plaquetas por microlitro (Dreisler & Kjer, 2019b). El PRP tiene un gran potencial regenerativo de los tejidos, ya que favorece la angiogénesis, migración, diferenciación y proliferación celular debido a su alto contenido en factores de crecimiento como factor de crecimiento endotelial vascular (VEGF), factor de crecimiento epidérmico (EGF), factor de crecimiento derivado de plaquetas (PDGF), factor de crecimiento transformante (TGF) y citocinas (Sameh et al, 2020) (Sharara et al, 2021). A diferencia de otros tratamientos regenerativos, la infusión de PRP es una técnica segura, asequible y menos invasiva en pacientes con endometrio alterado (Dreisler & Kjer, 2019b).…”