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Cao C, Chen Y, Li J, Xu Q, Liu X, Zhao R, Jiang Q, Zhou Q. Short-term reproductive outcomes analysis and prediction of the modified uterine stent treatment for mild to moderate intrauterine adhesions: experience at a single institution. BMC Womens Health 2024; 24:252. [PMID: 38654192 PMCID: PMC11036709 DOI: 10.1186/s12905-024-03098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To evaluate the efficacy of modified uterine stent in the treatment of mild-to-moderate intrauterine adhesions and explore the relative indicators affecting prognosis prediction. METHODS A total of 115 patients with mild-to-moderate intrauterine adhesions received a modified uterine stent placement after hysteroscopy adhesiolysis. The second-look hysteroscopy operated after 3 months surgery, and the third-look hysteroscopy operated after 6 months surgery if necessary. The stent was removed when the cavity shape was repaired, then the reproductive outcomes were followed up one year. RESULTS Menstrual blood volume, endometrial thickness and volume had increased significantly after 3 months surgery. The rates of cavity repaired were 86.96% (100/115) after 3 months surgery and 100% (115/115) after 6 months surgery cumulatively. Endometrial thickness after 3-months surgery was positively associated with uterine cavity shape repaired (P<0.01). The receive operating characteristic (ROC) curve showed the rate of uterine cavity shape repaired predicted by the model was 0.92, based on the endometrial thickness after 3-months surgery. The rate of pregnancy was 86.09% (99/115) in one year, while the rate of miscarriage accounted for 26.26% (26/99). The median time interval between stent removal and subsequent conception was 3 months. It showed adhesion recurrence was the risk factor for subsequent pregnancy (P<0.01). CONCLUSIONS A modified uterine stent placement under hysteroscopy was an effective approach for mild-to-moderate intrauterine adhesions, which is easy to operate and worthy for clinical promotion. Endometrial thickness measured by ultrasonography probably has predictive value in adhesion recurrence and subsequent pregnancy. TRIAL REGISTRATION ChiCTR2100051524. Date of registration (retrospectively registered): 26/09/2021.
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Affiliation(s)
- Chaoxia Cao
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, 401147, Yubei District, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, 401147, Yubei District, Chongqing, China
- Chongqing Research Center for Prevention and Control of Maternal and Child Diseases and Public Health, 401147, Yubei District, Chongqing, China
| | - Yinan Chen
- Department of Mathematics, School of Mathematics and Physics, University College London, Gower St, London, WC1E 6AE, UK
| | - Jinjin Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Qianjie Xu
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, 401147, Yubei District, Chongqing, China
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, 401147, Yubei District, Chongqing, China
- Chongqing Research Center for Prevention and Control of Maternal and Child Diseases and Public Health, 401147, Yubei District, Chongqing, China
| | - Ruikun Zhao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China
| | - Quanjia Jiang
- Department of Obstetrics and Gynecology, Chongqing Shapingba Maternity and Child Healthcare Hospital, Shapingba District, Chongqing, 401331, China
| | - Qin Zhou
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400016, China.
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Kalaitzopoulos DR, Themeli MZ, Grigoriadis G, Alterio MD, Vitale SG, Angioni S, Daniilidis A. Fertility, pregnancy and perioperative outcomes after operative hysteroscopy for uterine septum: a network meta-analysis. Arch Gynecol Obstet 2024; 309:731-744. [PMID: 37354236 DOI: 10.1007/s00404-023-07109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Septate uterus is a congenital malformation associated with adverse reproductive and pregnancy outcomes. It remains controversial whether hysteroscopic septoplasty should be recommended for the treatment of septate uterus, and it is also unclear if different hysteroscopic methods have more favorable outcomes. This study aims to compare the available hysteroscopic techniques of septoplasty for fertility, reproductive, and perioperative outcomes. METHODS This systematic review and meta-analysis was conducted following PRISMA guidelines. We searched Medline, Scopus, and Cochrane databases up to April 2023 without language restrictions. Eligible studies had to compare two or more different methods of hysteroscopic septoplasty in women with septate uterus and report on fertility and pregnancy outcomes after a follow-up. Perioperative outcomes were also examined. Data extraction was performed by two independent reviewers using a standardized form. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form and Revised Cochrane risk-of-bias tool (RoB 2). RESULTS Out of 561 studies identified, 9 were included in the systematic review and meta-analysis. The comparison of different hysteroscopic septoplasty techniques based on the energy used showed higher pregnancy rates after mechanical septoplasty in comparison to electrosurgery, while miscarriage and live birth rates were comparable. Laser vs. electrosurgery and mechanical techniques of septoplasty had comparable pregnancy, miscarriage, and live birth rates. The network meta-analysis after comparing every different method used showed significantly higher clinical pregnancy rate in scissor group in comparison to resectoscope. No significant differences were found among the techniques regarding miscarriage rate and live birth rate. CONCLUSION In summary, this systematic review and network meta-analysis suggests that hysteroscopic septoplasty with scissors is associated with higher pregnancy rates compared to resectoscope. However, the limited evidence available and small sample sizes in the included studies indicate that these findings should be interpreted with caution. Further studies are required to determine the effectiveness of various hysteroscopic techniques and guide clinical decision-making in the management of this condition.
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Affiliation(s)
- Dimitrios Rafail Kalaitzopoulos
- Department of Obstetric and Gynecology, Cantonal Hospital of Schaffhausen, Geissbergstrasse 81, 8208, Schaffhausen, Switzerland.
| | - Maria Zografou Themeli
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus Oberhausen, Virchowstrasse 20, 46047, Oberhausen, Germany
| | - Georgios Grigoriadis
- 2nd University Department in Obstetrics and Gynecology, School of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maurizio D Alterio
- University Department in Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | | | - Stefano Angioni
- University Department in Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - Angelos Daniilidis
- 1st University Department in Obstetrics and Gynecology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chen Y, Wang Y, Zhao Y, Zhang C. Clinical efficacy of hysteroscopic adhesiolysis combined with periodic balloon dilation for intrauterine adhesion in IVF treatment. Front Endocrinol (Lausanne) 2023; 14:1236447. [PMID: 37822593 PMCID: PMC10562708 DOI: 10.3389/fendo.2023.1236447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
Background Intrauterine adhesions (IUA), arising from diverse etiological factors, pose a significant threat to female fertility, particularly during in vitro fertilization (IVF) treatment. Objective To assess the effectiveness of hysteroscopic adhesiolysis (HA) combined with periodic balloon dilation in treating IUA and its impact on reproductive outcomes in women undergoing IVF treatment. Methods A total of 234 patients diagnosed with IUA were included in this study. The IUA women were categorized into three subgroups based on the severity of adhesion. All IUA patients underwent HA separation followed by periodic balloon dilation along with hormone replacement therapy (HRT). Frozen embryo transfer was performed post-treatment, and a comparative analysis of the general characteristics and clinical outcomes among the subgroups was conducted. The control group consisted of patients who underwent their first embryo transfer of HRT cycle without any uterine abnormalities, as assessed by the propensity score matching (PSM). The clinical outcomes of IUA group and control group were compared. Multivariate logistic regression analyses were employed to investigate the risk factors associated with live birth. Results ① The endometrial thickness was significantly increased post-operation compared to pre-operation in all three IUA subgroups (all P <0.001), with the most pronounced change observed in the severe IUA group. After treatment, normal uterine cavity was restored in 218 women (93.16%). ② The overall clinical pregnancy rate was 49.57% (116/234) and live birth rate was 29.91% (70/234). The clinical outcomes were similar among the three subgroups after first embryo transfer (all P>0.05). Multivariate logistic regression analyses revealed that age (aOR 0.878, 95% CI 0.817~0.944, P=0.001) and endometrial thickness after treatment (aOR 1.292, 95% CI 1.046~1.597, P=0.018) were the two significant risk factors for live birth rate. ③ Following the process of matching, a total of 114 patients were successfully enrolled in the control group. The baselines and the clinical outcomes were all comparable between the IUA group and control group (all P>0.05). Conclusion The combination of HA and periodic balloon dilation is beneficial for improving endometrial receptivity and has a significant clinical impact on patients with IUA undergoing IVF.
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Affiliation(s)
- Yuanhui Chen
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yiwen Wang
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Zhao
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Cuilian Zhang
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
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D'Urso V, Gulino FA, Incognito GG, Cimino M, Dilisi V, Di Stefano A, Gulisano M, Cannone F, Capriglione S, Palumbo M. Hysteroscopic Findings and Operative Treatment: All at Once? J Clin Med 2023; 12:4232. [PMID: 37445266 DOI: 10.3390/jcm12134232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called "office hysteroscopy" or "see-and-treat hysteroscopy", whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.
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Affiliation(s)
- Valentina D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Monia Cimino
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Valentina Dilisi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Alessandra Di Stefano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Marianna Gulisano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Francesco Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Ospedale "Santa Maria Alla Gruccia" Piazza del Volontariato 2, 52025 Montevarchi, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
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Zhuang LL, Wang K, Shen HL, Lin JH, Lu Y, Luo ZY, Wang WR. A comparison of special intrauterine balloons and intrauterine contraceptive devices in the treatment of intrauterine adhesions. Arch Gynecol Obstet 2023; 307:1873-1882. [PMID: 36897397 PMCID: PMC10147804 DOI: 10.1007/s00404-023-06993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE This study aimed to compare the efficacy of a special kind of intrauterine balloon (IUB) and that of an intrauterine contraception device (IUD) for patients with intrauterine adhesions (IUAs) after transcervical resection of adhesion (TCRA). METHODS In this retrospective cohort study, after TCRA, 31 patients received a special IUB, and 38 patients received an IUD. The Fisher exact test, logistic regression method, Kaplan-Meier method and Cox proportional hazards regression model were used for statistical analysis. A two-sided value of P < 0.05 was considered statistically significant. RESULTS The readhesion rate significantly differed between the IUB group and IUD group, at 15.39% and 54.06%, respectively (P = 0.002). For recurrent moderate IUA, patients in the IUB group had lower scores than patients in the IUD group (P = 0.035). There was a significant difference in the intrauterine pregnancy rate of IUA patients in the IUB group and IUD group after treatment, with rates of 55.56% and 14.29%, respectively (P = 0.015). CONCLUSION Patients in the special IUB group had better outcomes than those in the IUD group, which has a certain guiding significance for clinical work.
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Affiliation(s)
- Lin-Lin Zhuang
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China
| | - Kai Wang
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China
| | - Hai-Lan Shen
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China
| | - Jia-Hui Lin
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China
| | - Ye Lu
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Zhen-Yu Luo
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China.
| | - Wen-Rong Wang
- Department of Family Planning, Women and Children's Hospital, School of Medicine, Xiamen University, Siming District, Zhenhai Road, Xiamen, 361005, Fujian, China.
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Zhao X, Yang Y, Liao D, Traoré A, He S, Xu D. Correlative study of preoperative three-dimensional transvaginal ultrasound findings and ongoing pregnancy/live birth in patients with intrauterine adhesions following hysteroscopic adhesiolysis: a retrospective study. Quant Imaging Med Surg 2022; 12:2441-2453. [PMID: 35371937 PMCID: PMC8923839 DOI: 10.21037/qims-21-727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/02/2021] [Indexed: 03/22/2024]
Abstract
BACKGROUND Three-dimensional transvaginal ultrasound (3D-TVUS) has recently been adopted in the gynecological sciences as it provides an accurate illustration of adhesions and the extent of cavity damage, and hence, can be used as an essential tool for the prognosis of intrauterine adhesions (IUA). This study aims to demonstrate whether preoperative 3D-TVUS features are relevant to ongoing pregnancy and live births in patients with IUA following hysteroscopic adhesiolysis (HA). METHODS From February 22, 2018, to October 31, 2018, a total of 401 patients with moderate to severe IUA and underwent HA were retrospectively enrolled. Preoperative 3D-TVUS diagnosed data and the patients' basic information were collected, and patients were followed up over 2 years after HA for reproductive outcomes. The correlation between each imaging variable and ongoing pregnancy or live birth was analyzed by binary logistic regression. RESULTS Among the 401 patients, 143 had live births, 41 patients had abortions, and 217 patients were infertile. Thick endometrium was found to be favorable for ongoing pregnancy (ongoing pregnancy group =5.4±1.95 mm, no-ongoing pregnancy group =4.7±2.24 mm, P=0.0095) and live birth (live birth group=5.6±1.92 mm, no-live birth group =4.7±2.20 mm, P=0.0029). Scar contraction was not conducive for pregnancy, while the lower segmentation was not a risk factor for ongoing pregnancy (P=0.0003). It also was a risk factor for ongoing pregnancy (P<0.0001) and live birth (P<0.0001) when the segmentation of the endometrial absence was mainly in the upper and middle segments of the uterine cavity. The area under the curves (AUCs) of the prediction model for ongoing pregnancy and live birth were 0.9116 and 0.8751, respectively, based on the meaningful variables above combined with other clinical characteristics. CONCLUSIONS Preoperative 3D-TVUS features have a close correlation with ongoing pregnancy and live births in patients with IUA following HA, and can be applied for predicting ongoing pregnancy and live births in IUA patients post-HA.
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Affiliation(s)
- Xingping Zhao
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, ChangshaChina
| | - Yimin Yang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, ChangshaChina
| | - Dan Liao
- Department of Obstetrics and Gynecology, The People’s Hospital of Ningxiang, Ningxiang, China
| | - Absatou Traoré
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, ChangshaChina
| | - Sili He
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, ChangshaChina
| | - Dabao Xu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, ChangshaChina
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Wang J, Zheng F, Wang D, Yang Q. Case report: Hysteroscopy combined with a vaginal mold for severe recurrent vaginal adhesion and stenosis with pyocolpos after pelvic fracture in a 13-year-old female. Front Pediatr 2022; 10:966724. [PMID: 36340718 PMCID: PMC9634117 DOI: 10.3389/fped.2022.966724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Vaginal adhesions and stenosis are infrequent long-term sequelae following pediatric pelvic fractures. Patients may not present with signs and symptoms before menarche, leading to delayed diagnosis and treatment. We report an adolescent girl who presented with a post-abdominal trauma pelvic fracture and urethrovaginal fistula and subsequent severe vaginal adhesion, which resulted in infection and obstructive symptoms after menarche. Hysteroscopy-guided vaginal adhesion release using an epidural catheter and ultrasonography was performed, followed by vaginal dilation, to resolve obstructive symptoms. For girls with pelvic fractures, education on possible long-term sequelae is required, as is regular follow-up. Timely diagnosis and treatment are important, and hysteroscopic release of vaginal adhesion and postoperative regular vaginal dilation may be an effective treatment.
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Affiliation(s)
- Jiao Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fei Zheng
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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