DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175833

Diagnostic, therapeutic and prognostic aspects of uterine synechiae managed by hysteroscopy in the gyanecological endoscopic surgery and human reproductive teaching hospital

Etienne Belinga, Isidore Tompeen, Claude Cyrille Noa Ndoua, Junie Metogo Ntsama, Sandrine Mendibi, Jean Marie Kasia

Abstract


Background: Uterine synechiae refers to a total or partial union of the inner walls of the uterus resulting from endometrial trauma. It is a cause of reproductive failure. Until now, synechia was not optimally treated and has remained understudied in Cameroon. Objective of present study was to Evaluate the diagnostic, therapeutic and prognostic aspects of uterine synechiae treated by hysteroscopy.

Methods: We conducted a descriptive cross-sectional study with an analytical component from January 1st 2015 to July 31st 2017 at Yaounde. All patients diagnosed with uterine synechiae and treated with hysteroscopy were our sample. Sampling was consecutive. The chi-square test was used for the comparison of qualitative variables and Fisher's test for ANOVA variance analysis. The comparison of the averages was made by the Student's test. P-value less than 0.05 was considered as statistically significant.

Results: Hysteroscopies were indicated for uterine synechiae in 14.50%. Nulliparous were 56.67%. A history of curettage/aspiration was present in 66.66%. All of the patients had a form of infertility and 83.33% had menstrual disorders. Hysterosalpingography showed a better sensitivity (88%). After hysteroscopic treatment, 63.30% had a complete anatomical restitution. There is a significant correlation between the stage of severity of synechia and anatomical restitution (p=0.008; Spearman correlation coefficient=-0.477).

Conclusions: Uterine synechiae represent one-sixth of all indications for hysteroscopy and present clinically as menstrual disorder associated with infertility. A past history of uterine curettage is common. Hysterosalpingography has a better preoperative diagnostic sensitivity. Hysteroscopy allows optimal treatment.


Keywords


CHRACERH, Cameroon, Operative hysteroscopy, Prognosis, Uterine synechiae

Full Text:

PDF

References


Tchounzou R, Ngono M, Moifo B, Mbu RE. Treatment of uterine synechiae in the absence of hysteroscopy in semi-urban areas in Cameroon. Med Sante Trop. 2014;24:263-5.

Society TAF. The American Fertility Society classification of adnescal adhesions, distal tubal occlusion secondary to tubal ligatio, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1992;49:944-55.

Efetie ER. Reproductive outcome following treatment of intrauterine adhesions in Abuja, Nigeria. Niger J Clin Pract. 2006;9:164-8.

Daraï E, Deval B, Benifla JL, Guglielmina JN, Sitbon D, Filippini F, et al. Uterine synechias. EMC Gynecology. 1996;155-A-30:1-11.

Bergman P, Wehlin L. Post-traumatic intra-uterine synechiae. Acta Radiol. 1958;49:453-63.

McComb PF, Wagner BL. Simplified therapy for Asherman’s syndrome. Fertil Steril. 1997;68:1047-50.

Protopapas A, Shushan A, Magos A. Myometrial scoring: a new technique for the management of severe Asherman’s syndrome. Fertil Steril. 1998;69(5):860-4.

Daaloul W, Ouerdiane N, Masmoudi A, Ben HS, Bouguerra B, Sfar R. Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: report of 86 cases. Tunis Med. 2012;90(4):306-1.

Chanoufi MB, Chelli D, Ghaffari C. Uterine synechiae: results after hysteroscopic treatment in 127 cases. Gynecologist's Letter. 2006;30:9-14.

Kdous M, Hachicha R, Zhiou F, Ferchiou M, Chaker A, Meriah S. Fertility after hysteroscopic treatment of intra-uterine adhesions. Gynecol Obstet Fertil. 2003;31:422-8.

Roge P, D’ercole C, Cravello L, Boubli L, Blanc B. Hysteroscopic treatement of uterine synechias. A report of 102 case. J Gynecol Obstet Biol Reprod. 1996;25(1):33-40.

Hamou J, Cittadini E, Perino A. Diagnosis and management of intrauterine adhesions by microhysteroscopy. Acta Eur Fertil. 1983;14:117-23.

Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril. 1982;37:593-610.

Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158(6Pt1):1459-70.

Lancet M, Kessler I. Treatment of Asherman's syndrome with hysteroscopy and concomitant hysterography. J Gynecol Obstet Biol Reprod. 1986;15:464-6.

Blanc B, Boubli L. Uterine endoscopy. Paris Pradel editions;1996.

Rabau E, David A. Intrauterine adhesions: etiology, prevention, and treatment. Obstet Gynecol. 1963;22:626-9.

Polishuk WZ, Anteby SO, Weinstein D. Puerperal endometritis and intrauterine adhesions. Int Surg. 1975;60:418-20.

Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome: one century later. Fertil Steril. 2008;89(4):759-79.

Bricou A, Demaria F, Boquet B, Jouannic JM, Benifla JL. Uterine synechias. EMC-Gynecology. 158-A-10 2009:1-13.

Taylor PJ, Cumming DC, Hill PJ. Significance of intrauterine adhesions detected hysteroscopically in eumenorrheic infertile women and the role of antecedent curettage in their formation. Am J Obstet Gynecol. 1981;139(3):239-242.

Salle B, Gaucherand P, De Saint Hilaire P, Rudigoz RC. Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound. 1999;27:131-4.

Sylvestre C, Child TJ, Tulandi T, Tan SL. A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions. Fertil Steril. 2003;79:1222-5.

Eng CW, Tang PH, Ong CL. Hysterosalpingography: current applications. Singapore Med J. 2007;48:368-74.

Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand. 2001;80:986-93.

March CM, Israel R. Intrauterine adhesions secondary to elective abortion. Hysteroscopic diagnosis and management. Obstet Gynecol. 1976;48:422-4.

Chen FP, Soong YK, Hui YL. Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod. 1997;12:943-7.

Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol. 1996;65(1):109-113.