TITLE:
Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: A descriptive study
AUTHORS:
Adebiyi Gbadebo Adesiyun, Marliya S. Zayyan, Anthony Eka, Ijeoma Ozed Williams, Austin Ojabo
KEYWORDS:
Intrauterine Adhesion; Infertility; Risk Factor; Pregnancy Outcome
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.2,
February
19,
2014
ABSTRACT: Background: Intrauterine
adhesion is a clinical entity that may present with subfertility. However,
outcome of management depends on severity of intrauterine adhesion and type of
treatment intervention employed. Objective: To evaluate clinical and
investigative correlation of etiologic risk factors of intrauterine adhesion on
fertility and pregnancy outcome following treatment. Patients and Methods: A 5
years prospective observational study. Treatment employed includes transvaginal
blind intrauterine adhesiolysis, insertion of inert intrauterine device or
inflated Foley’s catheter balloon and oestrogen therapy. Inclusion criteria are
intrauterine adhesion as the only identifiable cause of infertility and post
treatment follows up for at least a year. Results: Over a period of 5 years, 63
patients with mean age of 31.6 years and age range of 21 to 42 years were
managed. Etiologic risk factors were dilatation and curettage 33 (52.4%), vacuum
aspiration 13 (20.6%), myomectomy 11 (17.5%) and caesarean section in 6 (9.5%) patients. Of
the 63 patients, 28 conceived giving a pregnancy rate of 44.4%. Nine out of the
28 patients that conceived had miscarriage, giving a miscarriage rate of 32.1%.
The highest pregnancy rate and lowest miscarriage rate were recorded in the
subgroup that had vacuum aspiration as their etiologic risk factor. Late
pregnancy complications encountered are preterm contractions 5 (26.3%),
placenta praevia 4 (21.1%), morbidly adherent placenta 5 (26.3%) and preterm
delivery in 2 (10.5%) patients. Route of delivery was per vaginum in 13 (68.4%)
patients and by caesarean section in 6 (31.6%)
patients. Live birth rate was 89.5%
(17/19 deliveries). There was no maternal mortality recorded.
Conclusion: Compared to other risk factors,
uterine vacuum aspiration was associated with higher fertility rate and
better pregnancy outcome.