Outcome of intrauterine adhesion management at a Nigerian tertiary hospital: a five-year review
Keywords:Aetiology, Intrauterine adhesion, Management, Outcome
Background: Intrauterine adhesion is a cause of menstrual abnormalities and infertility, which are leading complaints in gynaecological practice in Nigeria. Determining the aetiology and management option would help reduce this problem. The objective of this study was to determine the aetiology, mode of presentation, management option and outcome of intrauterine adhesions
Methods: A retrospective analysis of intrauterine adhesions at the University of Abuja Teaching Hospital over a five-year period from 2012 to 2016 was carried out. The case notes of the patients were retrieved from the records department and information extracted from these case notes using a questionnaire included the age, level of education, marital status, parity, complaints, predisposing factors, method of diagnosis, treatment method and outcome. Additional information was obtained from the theatre registered. The least follow up period was one year.
Results: There were 82 patients diagnosed with Intrauterine Adhesion over the study period giving an incidence of 1.6%. Fifty-nine case notes were available for analysis. The case note retrieval rate was 72%. Majority of the patients were between the age range of 30-34 years (21, 35.6%). Those with tertiary level of education constituted the majority (34, 57%). Nullipara constituted 54.2% (32) of the total population. Menstrual abnormalities were the most common complaint with 93.2% and this includes those with menstrual abnormalities and other complaints. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation (28, 47.5%). Majority of the patients had partial intrauterine adhesions (51, 86.4%). All patients were treated with adhesiolysis, Foleys catheter insertion and hormonal therapy for 3 cycles. There was not statistical significance between those who had blind adhesiolysis and hysteroscopic adhesiolysis in terms of outcome. Restoration of menstrual flow was in 25, (42.4%) while 3, (5.1%) had miscarriges and an equal no of patients had term delivery.
Conclusions: Dilatation and curettage is still a major predisposing factor in the development of intrauterine Adhesions. Blind adhesiolysis still has its place in the management of intrauterine adhesion in developing countries.
Asherman JG. Amenorrhoea Traumatic (atretica). J Obstet Gynecol Br Emp. 1948;55(2):23-30.
Balen A. Polycystic ovary syndrome and Secondary Ammenorrhoea. Edmonds KD, eds. Dewhurst’s textbook of obstetrics and gynaecology. Wiley-Blackwell companies; 2011:513-33.
Berman JM. Intrauterine adhesions. Semin Reprod Med. 2008;26:349-55.
Giwa-Osagie OF, Emuveyan EE. Evaluation of secondary Amenorrhoea. Nig Med Pract. 1968;7:79-83.
Otubu JA, Olanrewaju RS. Hysteroscopy in infertile Nigerian women. Afr J Med Sci. 1989;18:117-20.
Efena RE, Agustine CU and Ugochukwu VO. Clinical and demographic characteristics of women with intrauterine adhesion in Abuja, Nigeria. Obstet Gynaecol Int. 2012:435475.
Abiodun OM, Balogun OR, Fawole AA. Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, Central Nigeria. West Afr J Med. 2007;26:298-301.
Otubu JAM, Olanrewaju RS. Ashermans syndrome: experience in Jos University Teaching Hospital. Trop J Obstet Gynaecol. 1993;10:30-2.
Ogedengbe OK, Ogunmokun AA. The trend of intrauterine adhesions in Lagos Nigeria. Trop J Obstet Gynaecol. 1999;16:57-60.
Toaff R, Ballas S. Traumatic hypomenorrhoea: Amenorrhoea (Asherman’s syndrome). Fertil Steril. 1978;30:379-87.
Adesiyun AG, Zayyan MS, Eka A, Williams IO, Ojabo A. Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: a descriptive study. Open J Obstet Gynaecol. 2014;4:95-9.
Kwari SD, Idrisa A. Intrauterine adhesiolysis at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria: a 3-year review. Trop J Obstet Gynaecol. 2011;28:54-7.
Gaya SA, Adamu IS, Yakasai IA, Abubakar S. Review of intrauterine adhesiolysis at the Aminu Kano Treaching Hospital, Kano, Nigeria. Ann Afr Med. 2012;11:65-9.
Abbott JA, Deans R, Kingston A, Vancaillie TG. The management of intrauterine synechiae. Curr Opin Obstet Gynecol. 2009;21:335-41.
Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman’s syndrome-one century later. Fertil Steril. 2008;89:759-79.
March CM. Intrauterine adhesions. Obstet Gynaecol Clin North Am. 1995;22:491-505.
Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynaecol Scand. 2001;80:986-93.
Toaff R. Amenorrhoea hypomenorrhoea traumatic (syndrome di Asherman). Ani de la societa Italiana di Ginecol. 1962;49:258.
Wamsteker K, DeBlok S. Diagnostic hysteroscopy. Technique and documentation. Saunder, Sutton C and Daimond M, eds. Endoscopic surgery for gynaecologists, London. 1993;263-76.
Ogedengbe OK, Giwa Osagie OF, Adedeji OF, Oyeyinka O. Intrauterine adhesions in Lagos Nigeria. J Obstet Gynaecol. 1991;11:134-6.
Orhue AAE, Aziken ME, Igbefoh JO. A comparism of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003;82:49-56.
Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118.
Ozumba B, Ezegwui H. Intrauterine adhesions in an African population. Int J Gynaecol Obstet. 2002;7:37-38.
O’Neill SM, Agerbo E, Khashan AS, Kearney PM, Henriksen TB, Mortensen LC. Trial of labour or elective repeat caesarean section and the risk of neonatal and infant mortality: a population register-based cohort study. J Epidemiol Community Health. 2015;69:36-7.
Geidam AD, Audu BM, Kawuwa BM, Obed JY. Rising trend and indications of caesarean sections at the university of Maiduguri teaching hospital, Nigeria. Ann Afr Med. 2009;8:127-32.