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KMID : 0386019890010010035
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Korean Journal of Gynecology Endoscopy and Minimally Invasive Surgery
1989 Volume.1 No. 1 p.35 ~ p.36
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Management of Uterine Synechiae Using Hysteroscopy
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Abstract
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To elucidate the efficacy of-hysteroscopy in the diagnosis and treatment of uterine synechiae and to evaluate the outcomes. especially in respect of the restoration of menstrual function and fertility. of their management, 185 infertile patients diagnosed as uterine synechiae by hysterosalpingography (HSG) were examined using hysteroscopy and the managements for uterine synechiae which consisted of adhesiolysis, insertion of intrauterine device(IUD) and estrogen-progesterone(E-P) therapy were made from April. 1988 to September. 1989 at SNUH. The other infertility factors associated with._ uterine synechiae were also classified and analyzed.
The results were as follows
1. Among 185 infertile patients with uterine synechiae. primary infertility was in 86(46.5 %) and secondary in 99(53.5%) with habitual abortion in 1900.3%).
2. The most common infertility factor associated with uterine synechiae was tubal factor (118. 63.8%) ; pelvic adhesion in 20(10.8%). uterine factor in 8(4.3%). ovulatory factor in 4(2.2%) and male factor in 4(2.2%).
3. The most common etiologic factor of uterine synechiae was endometrial cureitage(88. 47.6%) ; cesarean section in 30.6%). myomectomy in 30.6%). Tompkins operation in 3(1.6%), hysterotomy in 2(1.1%). past history of tuberculosis in 25(13.5%) and unknown etiology in 6103.0%).
4.. Among 164 patients diagnosed as uterine synechiae by HSG. 142(86.6%) were confirmed by hysteroscopy whereas among 18 diagnosed as normal by HSG. 15(83.3%) were diagnosed as uterine synechiae by hysteroscopy.
5. According to the AFS classification of intrauterine adhesions. 2201.9%) were normal. 26(14.1%) in stage I(mild). 123(66.4%) in stage II(moderate) and 14(7.6%) in stage III(severe).
6. Follow-up HSG in 137 patients revealed normal uterine cavity in 40(29.2%), marked improvement in 45(32.8%), slight improvement in 33(24.1%) and no significant change in 1903.9%).
7. Follow-up hysteroscopy in 36 patients revealed normal cavity in 4( 11.1 %) and decrease in staging in 16(44.4%).
8. Among 87 patients without bilateral tubal occlusion. 15(17.2%) pregnancies were achieved with 5(33.3%) abortions.
These data suggest that an accurate diagnosis and lysis of intrauterine adhesions can be performed by hysteroscopy. Hysteroscopy is a useful diagnostic and therapeutic modality in the management of uterine synechiae.
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