ABSTRACT
Objective:To explore the similarities and differences of China Society of Gynecology Endoscopy (CSGE) and American Fertility Society (AFS) intrauterine adhesion (IUA) scoring criteria on IUA grading and their predictive value of reproductive prognosis.Methods:From January 2016 to January 2019, a total of 1 249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital. Totally, 378 patients with complete clinical data were enrolled, and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years, the pregnancy rate and live birth rate were statistical analysis.Results:(1) The grade of IUA according to AFS and CSGE scoring criteria was less consistent ( κ=0.295, P<0.001). Compared with AFS, the proportion of severe IUA cases diagnosed by CSGE was significantly lower [45.8% (173/378) vs 15.1% (57/378); RR=0.22, 95% CI: 0.15-0.30, P<0.01); the proportions of both mild and moderate IUA cases were significantly higher ( RR=4.16, 95% CI: 2.38-7.14; RR=2.38, 95% CI: 1.75-3.23; both P<0.01). (2) The pregnancy rates of mild, moderate and severe IUA diagnosed according to CSGE were 11/13, 64.5% (147/228), 31.8% (7/22), live birth rates were 11/13, 54.8% (125/228) and 22.7% (5/22), respectively; there were statistically significant differences between the groups (all P<0.01). The pregnancy rates of mild, moderate and severe IUA diagnosed based on AFS were 3/3, 66.9% (97/145) and 56.5% (65/115), respectively, with no statistically significant difference between the groups ( P>0.05). (3) IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates (CSGE: r=-0.210, r=-0.226; AFS: r=-0.130, r=-0.147; all P<0.05). Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS (3.889 vs 1.657, 3.983 vs 1.554, respectrvely). Conclusions:Compared with AFS, the IUA grade based on CSGE is better related with reproductive prognosis, suggesting that the CSGE standard might be more objective and comprehensive and has better predictive value for reproductive prognosis, thus avoiding overdiagnosis and overtreatment.
ABSTRACT
ObjectiveTo investigate the pharmacological effect and metabolic mechanism of Linderae Radix on the intrauterine adhesion （IUA） rat model. MethodAn IUA rat model was induced by mechanical injury and infection. Molecular biology and pharmacology techniques were employed to evaluate the inhibitory effect of Linderae Radix extract （LAE） on fibrosis in IUA. Serum metabolomics analysis based on gas chromatography-mass spectrometry （GC-MS） was conducted to explore the metabolic regulation mechanism of LAE. ResultAnimal experiments showed that LAE significantly improved the morphology and structural damage of uterine tissue cells in the IUA rat model， promoted endometrial proliferation， vascular regeneration， and morphological recovery， inhibited the mRNA expression of transforming growth factor-β1 （TGF-β1）， Smad2， and Smad3， and increased the expression of Smad7 mRNA to suppress fibrosis. Additionally， LAE significantly suppressed the levels of estrogen （E2）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and tumor necrosis factor-α （TNF-α） expression （P<0.01）， thereby improving the uterine microenvironment. Metabolomics analysis revealed significant metabolic abnormalities in the serum of IUA rats compared with the results in the normal group， and nine differential metabolites were identified. LAE effectively ameliorated these metabolic abnormalities， primarily by influencing six differential metabolites， including five shared metabolites among the nine identified markers： L-aspartic acid， L-pyroglutamic acid， L-serine， glucose， and L-norvaline. Pathway enrichment analysis indicated that the aminoacyl-tRNA biosynthesis pathway was the main affecting mechanism. ConclusionIn combination with the pharmacological research results， LAE effectively improved uterine damage and inhibited fibrosis in the IUA rat model. Its mechanism may involve the inhibition of the aminoacyl-tRNA biosynthesis pathway and the improvement of the microenvironment.
ABSTRACT
Although estrogen has crucial functions for endometrium growth, the specific dose and underlying molecular mechanism in intrauterine adhesion (IUA) remain unclear. In this study, we aimed to investigate the effects of estrogen on epithelial-mesenchymal transition (EMT) in normal and fibrotic endometrium, and the role of estrogen and Wnt/β-catenin signaling in the formation of endometrial fibrosis. CCK-8 and immunofluorescence assay were performed to access the proliferation of different concentrations of estrogen on normal human endometrial epithelial cells (hEECs). qRT-PCR and western blot assay were utilized to explore the effect of estrogen on EMT in normal and fibrotic endometrium, and main components of Wnt/β-catenin signaling pathway in vitro. Hematoxylin and eosin and Masson staining were used to evaluate the effect of estrogen on endometrial morphology and fibrosis in vivo. Our results indicated that the proliferation of normal hEECs was inhibited by estrogen at a concentration of 30 nM accompanied by upregulation of mesenchymal markers and downregulation of epithelial markers. Interestingly, in the model of transforming growth factor β1 (TGF-β1)-induced endometrial fibrosis, the same concentration of estrogen inhibited the process of EMT, which might be partially mediated by regulation of the Wnt/β-catenin pathway. In addition, relatively high doses of estrogen efficiently increased the number of endometrial glands and reduced the area of fibrosis as determined by the reduction of EMT in IUA animal models. Taken together, our results demonstrated that an appropriate concentration of estrogen may prevent the occurrence and development of IUA by inhibiting the TGF-β1-induced EMT and activating the Wnt/β-catenin pathway.
Subject(s)
Humans , Animals , Female , Uterine Diseases , Transforming Growth Factor beta1 , Epithelial-Mesenchymal Transition , Estrogens , Wnt Signaling PathwayABSTRACT
Objective To compare the analgesic effect and adverse reactions of oxycodone versus morphine after transcervical resection of adhesions (TCRA). Methods Sixty patients undergoing hysteroscopic TCRA under general anesthesia in Dalian Municipal Woman and Children′s Medical Center were randomly assigned to the test group or control group with 30 patients in each group; the test group received oxycodone 0.1 mg/kg (Q group), and the control group received morphine 0.1 mg/kg (M group). Both group was followed by propofol 2—3 mg/kg, as well as laryngeal mask airway (LMA) insertion after loss of consciousness to maintain ventilation. Propofol 6—10 mg/kg/h and remifentanil 0.1—0.2 μg/kg min were administered intraoperatively to maintain anesthesia. The visual analogue scale (VAS) score, sedation score and number of rescue medications were recorded immediately and 1 h, 2 h after the patient was sent to postoperative recovery room. The incidences of body movement, nausea and vomiting and pruritus after LMA insertion were recorded. Results There were no statistically significant differences between the two groups in VAS score, sedation score ,nausea and vomiting, itchy skin or the number of rescue medications at any post-recovery time point (P > 0.05); the incidence of body movements during LMA insertion was lower in M group: 13.3%(4/30) vs 36.7%(11/30), with statistically significant difference (P < 0.05). Conclusions Oxycodone could provide favorable postoperative analgesia for patients with intrauterine adhesion, with low incidence of adverse reactions.
ABSTRACT
Objective: To observe the effect of thermosensitive hydroxybutyl chitosan (HBC) hydrogel in the prevention of intrauterine adhesion in New Zealand white rabbits. Methods: Eighteen female New Zealand rabbits were randomly divided into 3 groups, i. e., normal control group, model group and HBC group. Normal control group underwent sham operation. The models of intrauterine adhesion were constructed by both mechanical damage and infection in model group and HBC group. In HBC group, 2 mL 1.5% thermosensitive HBC hydrogel was injected into the uterine cavity immediately after injury. Two rabbits were killed in each group 1 week, 2 weeks and 4 weeks after operation, respectively. The bilateral uterine tissues were collected. The endometrial morphology and quantity of glands were observed by hematoxylin-eosin staining. The area of fibrosis in endometrium was measured by Masson staining. Results: One week after operation, compared with normal control group, the columnar epithelial cells of endometrium gradually disappeared and the ratio of endometrial fibrosis area increased significantly in the other two groups. The number of glands also decreased. After 2 weeks, intrauterine adhesion was observed in model group, and the ratio of endometrial fibrosis area continued increasing, and the number of glands decreased further. However, in HBC group, there was no residual hydrogel in the uterine cavity, and the ratio of endometrial fibrosis area decreased and the number of glands increased. After 4 weeks, there was a recovery of columnar epithelium cells, the ratio of endometrial fibrosis area, and the number of glands in HBC group, which returned to the normal level. Conclusion: Thermosensitive HBC hydrogel can effectively prevent intrauterine adhesion in New Zealand white rabbits.
ABSTRACT
The pathogenesis and therapeutic treatment of intrauterine adhesions (IUAs) remain unsolved, highlighting the need for stable and effective experimental animal models. In this study, uterine electrocoagulation of twenty-one female New Zealand White rabbits was carried out to establish an IUA model. As rabbits have two completely separate uterine horns, each rabbit had its own internal control: one uterine horn was given an electrothermal injury (Group A, n=21), and the contralateral uterine horn received no treatment and served as the control (Group B, n=21). The endometrial morphology, number of endometrial glands, area of endometrial fibrosis, and number of implanted fetuses were compared between the two groups. In Group A, the numbers of endometrial glands on Days 7 and 14 and the number of implanted fetuses were significantly lower than those in Group B (P<0.05, P<0.05, and P<0.01, respectively), while the ratio of the area with endometrial stromal fibrosis to the total endometrial area was significantly increased (P<0.01). These results suggest that this method of electrothermal injury is effective for the establishment of a rabbit IUA model between 7 and 14 d after surgery.
Subject(s)
Animals , Female , Pregnancy , Rabbits , Disease Models, Animal , Electrocoagulation , Endometrium , Pathology , Tissue Adhesions , Pathology , Therapeutics , Uterine DiseasesABSTRACT
OBJECTIVE:To study the clinical effects of curettage under hysteroscopy combined with estrogen and progesterone in preventing intrauterine adhesion after missed abortion.METHODS:A total of 120 patients receiving missed abortion selected from gynecology department of our hospital during Jun.2014-Jun.2016 were randomly divided into observation group (60 cases) and control group (60 cases) according to seguential coding.Observation group was given estradiol valerate 3 mg,qd,for 5 d in total,received curettage under hysteroscope,and was given Estradiol valerate tablet/Estmdiol valerate cyproterone tablet one tablet,qd after surgery,for 21 d.Control group received routine curettage and didn't take estrogen and progesterone during the perioperative period.The time of vaginal bleeding,endometrial thickness 14 d after surgery,the amout of vaginal bleeding with in 3 months after surgery,intrauterine adhesion,the occurrence of ADR were observed in 2 groups.RESULTS:In observation group,57 cases completed the study except that 2 cases withdrew from the study due to the amount of vaginal bleeding as much as menstrual volume and 1 case withdrew from the study due to pregnancy tissue self-discharge.The duration of postoperative vaginal bleeding was (3.2 ±1.1) d in observation group and (5.4 ± 1.9) d in control group.The endometrial thickness of observation group was (8.04 ± 1.52)mm and that of control group was (5.27 ± 2.36) mm;the incidence of intrauterine adhesion was 3.5％ in observation group (2/57)and 15％ in control group (9/60).Above indexes of observation group were better than those of control group (P＜0.05).CONCLUSIONS:Curettage under hysteroscope combined with estrogen and progesterone helps to reduce post-curettage vaginal bleeding,promote endometrial repair and prevent intrauterine adhesion so as to protect women's reproductive ability.
ABSTRACT
Objective To compare Masson staining,van Gieson staining,and Sirius red staining for evaluation of an intrauterine adhesion(IUA)model in rats. Methods In total,24 female adult Sprague-Dawley rats were selected and bilateral uteri exposed. To establish an IUA rat model, the left uterus was cut and the endometrium scraped using a scalpel. The right uterus was used as a control. Fourteen days after surgery, all uteri were collected for histological evaluation of IUA by hematoxylin and eosin(HE)staining,Masson staining,van Gieson staining,and Sirius red staining. Results HE staining showed that the endometrial epithelial layer of the uterus was absent, with a smaller number of endometrial glands than the control uterus(P < 0.01). Collagen fibers were clearly visible using all special staining method. The fibrotic area rate of uteri by Masson staining(using toluidine blue)was higher than Masson staining(using light green),van Gieson staining,and Sirius red staining(P< 0.01). Under polarized light,type I and type III collagen fibers were clearly distinguished by Sirius red staining,but not using Masson and van Gieson staining. Conclusions Sirius red staining is a superior method than Masson and van Gieson staining for evaluation of fibrosis in IUA and can also differentiate collagen fiber types.
ABSTRACT
Despite the sharply development of reproductive science,the treatment for infertility has arrived at its bottle neck. Being a common cause of preganancy failure,intrauterine adhension(IUA)is getting widespread attention.A new treatment for IUA has brought into being when the stem cell theory of endometrial regeneration was presented.This paper summarizes the research progress of both treatment and etiology of IUA.
ABSTRACT
To explore the possibility of periodic treatment of high dose asteroidal valerate (E2V) after hysteroscopy surgery on serious intrauterine adhesion. Methods The post-operative effects of periodic high-dose E2V treatment was compared with retrospective analysis on 62 cases of serious intrauterine adhesion and their clinical files. The cases were divided to 3 groups: immediate high-dose periodic treatment of E2V after hysteroscopy electric resection + contraceptive ring fitting (experiment group I), low-dose periodic treatment of E2V (experiment group II), and Irregular use of hormone treatment (control group). Results The effective rate of menstruation recovery of experiment group I and that of experiment group II are higher than control group (P＜0. 05);experiment group I is higher than experiment group II (P＜0. 05). The effective rate of Intrauterine recovery of experiment group I is higher than experiment group II and control group(P＜0. 05); the curative effect of experiment group I is higher than experiment group II (P＜0. 05). The endometrium of experiment group I is thicker than experiment group II and control group (P＜0. 05). Conclusion The use of high dose asteroidal valerate after hysteroscopy surgery on serious intrauterine adhesion, which improves the treatment effectively, is reliable and safe.
ABSTRACT
Objective To build a rat model of intrauterine adhesion (IUA) by whole layer removal of endometrium in order to provide a suitable animal model for the treatment and experimental study of endometrial lesions and IUA.Methods According to different scopes of endometrial excision,105 female SD rats were divided into group A (2.5 cm × 0.5 cm),group B (2.5 cm × 0.25 cm) and group C (sham operation group) with 35 rats in each group.Uterine tissues of rats were collected 3,7,15 and 30 days after surgery.The ratio of uterine cavity narrow and congestion was recorded,the number of glands in the endometrium and the ratio of endometrial fibrosis area was counted,microvascular density (MVD) was measured,and pregnancy rate of rats in each group were observed to compare the two excision methods.Results The ratio of fibrosis area in group A and group B (0.892 ± 0.068,0.562 ± 0.027) were higher than that in group C (0.374 ± 0.074).Uterus patency scores in group A and group B (1.87 ± 0.16,1.20 ± 0.17) were both significantly higher than that in group C (0.68 ±0.098).The differences were statistically significant (P ＜ 0.001).The numbers of glands in the endometrium 30 days after surgery in group A,B and C were 7.35 ± 2.19,14.5 ± 2.43 and 15.56 ± 2.63,respectively,significantly less in group A than that in group B and C (both P＜0.001),while there was no statistical difference between group B and C (P =0.054).The MVD in group A,B and C were 16.06 ± 2.11,24.6 ± 2.34 and 26.37 ± 5.09,respectively,significantly less in group A than that in group B and C (both P＜0.001),while there was no statistical differences between group B and C (P=0.303).The rates of pregnancy in group A,B and C were 20％,33.3％ and 100％,respectively,obviously lower in group A than that in group B and C (P＜0.05).Conclusions The method of whole layer removal of endometriun had a high success rate in establishing a stable and effective rat model of IUA.
ABSTRACT
Objective To analyze the diagnostic value of transvaginal three-dimensional ultrasound in intrauterine adhesion.Methods The data in 75 patients with intrauterine adhesion confirmed by hysteroscopy surgery and conducting transvaginal twodimensional and three-dimensional ultrasound examination in this hospital from November 2014 to November 2016 were retrospectively analyzed.Results The diagnostic accuracy rate of the three-dimensional transvaginal ultrasound for diagnosing intrauterine adhesion reached 87.7 ％,which of two-dimensional ultrasound reached 69.2 ％;the accuracy rates of transvaginal two-dimensional ultrasound for detecting mild,middle and severe intrauterine adhesion were 56.7％,76.9％ and 88.9％ respectively,while which of transvaginal three-dimensional ultrasound were 76.7 ％,96.2 ％ and 100.0 ％ respectively;the accuracy rates of transvaginal two-dimensional ultrasound for detecting peripheral,central and mixed intrauterine adhesion were 66.7％,76.7％ and 54.5％ respectively,while which of transvaginal three-dimensional ultrasound were 83.3％,88.7％ and 100.0％ respectively;the accuracy rate of three-dimensional transvaginal ultrasound was significantly superior to that of transvaginal two-dimensional ultrasound,the difference was statistically significant (P＜0.05).Conclusion Compared with transvaginal two-dimensional ultrasound,transvaginal three-dimensional ultrasound is more accuracy in diagnosing intrauterine adhesion and can provide more information for clinical doctors.
ABSTRACT
Objective To explore the effects of different intrauterine adhesion (IUA) classification systems on predicting the IUA prognosis.Methods One hundred cases were selected as the subjects in present study from those diagnosed with IUA and underwent surgery in Zhujiang Hospital of Southern Medical University from Jan.2010 to Jan.2017,and were followed up for two years.According to the actual situation,all patients were scored by March,AFS,ESGE and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate,live birth rate and effective rate within 2 years after surgery.Results ESGE classification had a good effect on predicting the postoperative live birth rate and effective rate,and a certain predictive effect on pregnant rate,with the area under curve (AUC) of 0.722,0.754 and 0.635,respectively.March classification had a certain effect on predicting the postoperative live birth rate and effective rate with AUC of 0.635,0.754,respectively,but had a poor effect on predicting pregnant rate.AFS classification and China classification had poor effect on predicting the IUA prognosis.Conclusion ESGE classification system is better than the other systems including March,AFS and Chinese classification,on predicting the IUA prognosis,but further verification in large sample size is still required.
ABSTRACT
Objective To discuss clinical efficacy of taking drospirenone and ethinylestradiol tablets in preventing intrauterine adhesion after missed abortion curettage with b-ultrasonic observation.Methods216 cases of study objects provided with missed abortion curettage with b-ultrasonic observation were divided into control group with 108 cases and research group with 108 cases.Patients in control group were provided with conventional treatment after surgery, while those in research group were provided with conventional treatment and drospirenone and ethinylestradiol tablets.Two groups were compared for condition after surgery such as intrauterine adhesion in 1month after treatment, secondary pregnancy, infertility and abortion in 1 year after treatment.ResultsTime of vaginal bleeding, pelvic effusion and time of return of menses in research group were significantly lower than those in control group, with difference having statistical significance (t=6.114,t=9.481,t=9.201,P0.05).In the case of infertility rate and rate of abortion in 1 year after treatment, control group was higher than research group with difference having statistical significance (χ2=4.317,χ2=5.225,P<0.05).ConclusionTaking drospirenone and ethinylestradiol tablets after missed abortion curettage with b-ultrasonic observation can effectively prevent intrauterine adhesion, which can also reduce complications such as abortion and infertility, therefore, it shall be applied in accordance with specific condition of patients.
ABSTRACT
Objective To investigate the knowledge degree of the risk of intrauterine adhesions in patients with induced abortion.Methods A total of 360 patients,who accepted induced abortion in gynecological clinic from June to November 2015,were evaluated using self-edited Assessment on Doctor-patient Communication in Gynecological Outpatient Clinic.Results 83.9％ patients could provide previous pregnancy and fertility history,24.2％patients could repeat clearly therapeutic advice and attentions after induced abortion,13.1 ％ patients understood the risk of uterine adhesion,9.7 ％ patients understood the influnce of uterine adhesion on fertility and 31.9 ％ patients wished to prevent uterine adhesion with drugs,patients with spontaneous abortion and multiple abortion history understood the risk with 67.6％ and 31.5％ respectively,overall 61.9％ patients felt the pressure and wished to get more attetions.Conclusion We need to strengthen the risk informing of intrauterine adhesions after induced abortion.
ABSTRACT
[Objective]Sum up the academic thought and clinical experience of Professor CHEN Xia syndrome differentiation of intrauterine adhesion [Methods]By learning from CHEN Xia and studying the medical record of intrauterine adhesion, sum up the clinical experience of Professor CHEN Xia from etiology and pathogenesis, therapeutic methods, administered medical herbs and prescription ,and features of the clinical treatment. [Results]For intrauterine adhesions caused by artificial abortions, Professor CHEN considered that this disease took deficiency of kidney as original cause and blood stasis as the superficial cause.And in accordance with the pathogenesis,Professor Chen pointed out that the basic big law of treatment was tonifying kidney to nourish the endometrium and removing blood stasis to anti-inflammatory reaction,and developed a prescription named"Bushen Huayu formula".What's more, Professor CHEN is deft at staging treatment and tonifying kidney and regulating menstrual cycle. In the menstrual period, Professor CHEN emphasizes the points that it is better to clear heat and activate blood; In the non-menstrual period, she attaches importance to tonify kidney. Meanwhile, Professor CHEN proposes to integrate Chinese and western medicine therapy and combine with psychotherapy. [Conclusion]Professor CHEN 's rich experience in clinical medicine is worth clinical promotion.
ABSTRACT
[Objective]Sum up the academic thought and clinical experience of Professor CHEN Xia syndrome differentiation of intrauterine adhesion [Methods]By learning from CHEN Xia and studying the medical record of intrauterine adhesion, sum up the clinical experience of Professor CHEN Xia from etiology and pathogenesis, therapeutic methods, administered medical herbs and prescription ,and features of the clinical treatment. [Results]For intrauterine adhesions caused by artificial abortions, Professor CHEN considered that this disease took deficiency of kidney as original cause and blood stasis as the superficial cause.And in accordance with the pathogenesis,Professor Chen pointed out that the basic big law of treatment was tonifying kidney to nourish the endometrium and removing blood stasis to anti-inflammatory reaction,and developed a prescription named"Bushen Huayu formula".What's more, Professor CHEN is deft at staging treatment and tonifying kidney and regulating menstrual cycle. In the menstrual period, Professor CHEN emphasizes the points that it is better to clear heat and activate blood; In the non-menstrual period, she attaches importance to tonify kidney. Meanwhile, Professor CHEN proposes to integrate Chinese and western medicine therapy and combine with psychotherapy. [Conclusion]Professor CHEN 's rich experience in clinical medicine is worth clinical promotion.
ABSTRACT
Objective To investigate the preventive effect and the mechanism of estradiol on the formation of intrauterine adhesion in rats. Methods Thirty female SD rats were randomly assigned into 5 groups (6 each), and rats intrauterine adhesion model was reproduced by curettage and infection. Estradiol valerate was gavaged for prevention of adhesion. Rats in control group (A) were not given intrauterine injury or estradiol. In physiological estrogen group (B) intrauterine injury was reproduced, but no estradiol valerate was given. The rats in low dose estrogen group (C), moderate dose estrogen group (D) and high dose estrogen group (E) were treated with estradiol valerate of 0.206, 0.514 or 1.028mg/(kg·d) respectively after reproduction of the model. ELISA was used to determine the serum concentrations of estradiol. HE staining was performed to observe the number of endometrial glands in rats. Masson staining was used to calculate the area of endometrial fibrosis, and immunohistochemical method was employed to detect the expressions of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-β). Results On account of administration of estradiol valerate, the serum estradiol levels were significantly higher in group C, D and E than in group A and B, and the serum estradiol levels increased along with the increase of dosage of estradiol (P<0.05). Compared with group B, rats in group C, D and E presented increased number of endometrial glands and decreased ratio of endometrial fibrosis area (P<0.05), but no significant difference was found between group D and group E. Compare to group B, rats in Group C, D and E showed higher MMP-9 levels and lower TGF-β levels (P<0.05), but no significant difference was found between group D and group E. Conclusion Estradiol may reduce the formation of intrauterine adhesion, and the effect is positively correlated with the dosage of estradiol used.
ABSTRACT
Objective To investigate the prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection after separation of severe intrauterine adhesions.Methods A total of 97 severe intrauterine adhesions patients after transcervical resection of adhesions were divided into group A,B,C:group A placed intrauterine device and oral intook progynova 1 mg/d after 2 days of surgery,3 times/d,for 3 months; group B placed intrauterine device and oral intook progynova 3 mg/d after 2 days of surgery,3 times/d,for 3 months; group C with the same treatment as group B with further hystemscopy regular inspection every month.Regular follow-up data were collected in the following 3 months to compare endometrial thickness,re-adhesion occurrence and treatment effect in different groups.Results After 3 months of treatment,endometrial thickness of group B and group C was higher than that in group A [(0.83 ± 0.23),(0.99 ± 0.28) cm vs.(0.54 ± 0.18) cm],group C was higher than group B,and there were significant differences (P＜ 0.05).The effective rate in group B and group C was higher than that in group A [75.00％(24/32),90.32％(28/31) vs.61.76％(21/34)],group C was higher than group B,and there were significant differences (P＜ 0.05).The occurrence rate of re-adhesion in group B and group C was lower than that in group A [21.88％(7/32),9.68％(3/31)vs.38.23％(13/34)],group C was higher than group B,and there were significant differences (P ＜ 0.05).Conclusion The prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection is effective and superior.
ABSTRACT
Asherman syndrome is an acquired condition characterized by the formation of adhesions in the uterine cavity. This condition is often caused by trauma to the endometrium, which mostly happens after currettage or post-partum, and can produce several complications such as menstrual disturbances, infertility, or recurrent abortion. The management of Asherman syndrome requires complete actions which can be summarized with the acronym PRACTICE, consisting of prevention, anticipation, comprehensive therapy, timely surveillance of subsequent pregnancies, investigation and continuing education. The prevention and anticipation aspects can be performed through reduction of invasive methods of therapy such as currettage, prophylactic therapy for adhesions such as antibiotics and post-estrogen therapy for high risk patients, and the use of instruments that do less damage to the uterine walls. The comprehensive therapy that become the method of choice is operative lysis using hysteroscopy, which provides direct visualization of the adhesion. To prevent reccurrence, especially to patients planning to have subsequent pregnancies, timely surveillance of the next pregnancies for high risk patients should be performed at hospital, with complete work-ups. Lastly, evaluation of operative results and continuing education to explain prognoses to the patient should be also performed.