Background: Intrauterine adhesions (IUA), also known as Asherman's syndrome, represent a significant complication following hysteroscopic myomectomy with potential implications for reproductive outcomes. This prospective observational study aimed to determine the incidence of intrauterine synechiae using second-look hysteroscopy and evaluate the efficacy of early adhesiolysis.
Methods: A total of 50 patients undergoing hysteroscopic myomectomy for submucosal fibroids at the Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Hospital, Jaipur, were enrolled from January 2021 to June 2022. All patients underwent second-look hysteroscopy at 6-8 weeks post-surgery. Adhesions were graded according to the American Society for Reproductive Medicine (ASRM) classification, and adhesiolysis was performed in the same sitting when present.
Results: Of the 50 patients studied, 10% (5/50) developed intrauterine adhesions following hysteroscopic myomectomy. All identified adhesions were ASRM Stage 1 (mild grade). Three cases (6%) showed adhesions involving less than 1/3rd of the uterine cavity, while 2 cases (4%) demonstrated adhesions involving 1/3rd to 2/3rd of the cavity. All adhesions were filmy in nature with no dense adhesions observed. Following adhesiolysis, 100% of patients maintained normal menstrual patterns with no cases of hypomenorrhea or amenorrhea.
Conclusion: Early second-look hysteroscopy following hysteroscopic myomectomy is an effective diagnostic and therapeutic procedure for detecting and treating newly formed post-operative intrauterine adhesions. This approach prevents progression to severe adhesions and reduces the risk of menstrual abnormalities and reproductive complications.
International Journal of Clinical Obstetrics and Gynaecology
Indexed in Index Copernicus
Research Journals