Comprehensive treatment of moderate and severe intrauterine adhesions in reproductive age woman.
Leyla Adamyan (RU), Patimat Khirieva (RU), Sergey Martynov (RU)
[Adamyan] Scientific Centre for Obstetrics, Gynecology and Perinatology named after V. I. Kulakov, Moscow, Russia , [Khirieva] Scientific Centre for Obstetrics, Gynecology and Perinatology named after V. I. Kulakov, Moscow, Russia, [Martynov] Scientific Centre for Obstetrics, Gynecology and Perinatology named after V. I. Kulakov, Moscow, Russia
Objective: To investigate the feasibility and success rate of comprehensive treatment of intrauterine adhesions (IUA).Methods: The therapeutic plan included: 1) hysteroscopy to confirm the diagnosis and evaluate the severity of disease followed by hysteroscopic adhesiolysis 2) physiotherapy using preformed physical factors, such as magnetic-therapy, laser-therapy magnetolasertherapy; 3) postoperative cyclic hormone therapy with high doses of estrogens to enhance endometrial proliferation. 4) trophotropic therapy to improve microcirculation in the vessels, supplying the uterus and appendages. The severity of IUA was determined based on the March classification. At grade I treatment included the first 2 points of plan. At grades II and III treatment included all points of plan. Recurrence of IUA was assessed after 3 months of therapy by hysteroscopic control. Patients:246 patients with mild, moderate, and severe IUAs underwent hysteroscopic adhesiolysis in our hospital between September 2014 to December 2016.Main Outcome Measures: normalization of menstrual blood flow occurred; recurrence rate according results of TVU and Hysteroscopy.Results: Intraoperatively grade I of IUA was established in 66,2% (163) of patients, grade II- 16,2% (40), grade III- 17,4% (43). 78% (191) of patients experienced completely restored uterine cavity. Normal menses after treatment had 89% (218) of patients, hypomenorrea had 11% (28) of patients.The overall conception rate after hysteroscopic adhesiolysis was 56%, which decreased with IUAs severity (mild, 67%; moderate, 50%; severe, 23%). The intrauterine adhesions recurrence rate was 3% in I grade, 37% in II grade, 88% in III grade. Conclusions: Complex treatment of intrauterine adhesions has successful recurrence rate of intrauterine adhesions especially at high grades of IUA.