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  • Title: Intrauterine adhesions: current diagnostic and therapeutic trends.
    Author: Fedele L, Vercellini P, Viezzoli T, Ricciardiello O, Zamberletti D.
    Journal: Acta Eur Fertil; 1986; 17(1):31-7. PubMed ID: 2941961.
    Abstract:
    In the period January 1981-December 1984, 31 cases of intrauterine adhesions (8 severe, 10 moderate and 13 minimal) were diagnosed at the First Department of Obstetrics and Gynecology, University of Milan. This pathology had altered the menstrual function in 21 subjects and reproductive capacity in 27. Synecholysis was performed at hysteroscopy, followed by application of an IUD in 7 patients and sequential treatment with estrogens and progestins in 22. After treatment 67.7% of the women had normal menstruation, and 40.7% of those wanting a child achieved pregnancy with live birth. Repeat hysterography and hysteroscopy after several months showed complete normalization of the uterine cavity in 62.5% of the women, and persistence of minimal and moderate adhesions in 25% and 12.5% respectively. Dissection with miniature scissors under visual control, followed by application of an IUD and sequential administration of estrogens and progestins seems at present the most effective therapeutic regimen for intrauterine adhesions. 31 cases of intrauterine adhesions were diagnosed over the January 1981-December 1984 period at the First Department of Obstetrics and Gynecology, University of Milan (Italy). Table IV presents the relevant details of the subjects' history prior to diagnosis. Menstrual abnormalities were present in 21 subjects -- amenorrhea in 7 and hypomenorrhea in 14. 27 of the women wanted a child. Their obstetric history showed habitual abortion in 19 cases, secondary sterility in 7 cases, and primary sterility in 1. Amenorrhea was the only reason for seeking consultation in the other 4 cases. A complete and basic screening of the couple showed no other important factors causing infertility. Hysterosalpingography always preceded the endoscopic evaluation. Synechiae were evaluated as severe in 8 cases, moderate in 10, and minimal in 13. A rigid hysteroscope of 4 mm diameter was inserted in a 5 mm diagnostic sheath and a 7 mm opering sheath. The uterine cavity was distended by C02 in 10 cases and with macromolecular dextran in 21. Lysis was performed in 15 cases by multiple pressures of the extremity of the tip of the outer sleeve of the hysteroscope and in 12 with rigid miniature scissors introduced through the operating sheath. In the other 4 cases, intervention could not be completed for technical reasons. An IUD was inserted postoperatively in 7 patients; sequential estrogen-progestin treatment was prescribed for 22 patients. A repeat hysterosalpingography was performed on 16 women; 12 underwent a 2nd-look hysteroscopy. In regard to menstrual function, the results were good overall. Over 2/3 of the patients reported complete normality of menstrual flow, and the number of subjects with hypomenorrhea dropped from 45.2% to 25.8%. Less satisfactory results were obtained in the 7 patients with amenorrhea: eumenorrhea in 2; partial restoration of menstrual flow in 3; and no flow in 2. Reproductive status did not improve along with restoration of menstrual function. The not corrected pregnancy rate was 70%; the pregnancies with live births were under 41%. The number of abortions was substantially reduced but even so 45% of the conceptions underwent spontaneous abortion. After correction of minimal interuterine adhesions, the reproductive prognosis could be regarded as moderately good. The same was not the case for moderate adhesions. In the presence of extensive pathology, no pregnancy was carried to term.
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