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Meta‐analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis
Author(s) -
Zheng Fei,
Zhu Bin,
Liu Yumo,
Wang Ruifeng,
Cui Yuechong
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12635
Subject(s) - medicine , hysteroscopy , adhesion , relative risk , amnion , randomized controlled trial , obstetrics , meta analysis , pregnancy , abortion , gynecology , confidence interval , surgery , fetus , chemistry , organic chemistry , biology , genetics
Background Various adjuvant therapies have failed to improve clinical symptoms and pregnancy rates among patients with moderate‐to‐severe intrauterine adhesion. Objectives To evaluate the ability of amniotic membrane to prevent the recurrence of intrauterine adhesion after hysteroscopic adhesiolysis. Search strategy The Cochrane Library, Embase, and PubMed databases were searched for articles published before December 31, 2017, using the terms: (“amnion”) and (“intrauterine adhesions” or “Asherman syndrome” or “ IUA ” or “endometrial injury” or “uterine adhesion” or “hysteroscopic” or “hysteroscopic adhesiolysis”). Selection criteria Randomized controlled trials of amniotic membrane therapy after hysteroscopic adhesiolysis. Data collection and analysis Four studies were included in the meta‐analysis (300 patients in total). Dichotomous outcomes were expressed as relative risk ( RR ) with 95% confidence intervals ( CI s). Continuous variables were expressed as mean difference. Main results Amniotic membrane increased menstrual blood volume after hysteroscopic adhesiolysis (mean difference 6.15, 95% CI 4.20–8.11; P <0.001). By contrast, this treatment did not affect the rates of intrauterine adhesion recurrence ( RR 0.84, 95% CI 0.61–1.16; P =0.290); pregnancy ( RR 1.40, 95% CI 0.78–2.50; P =0.260); or spontaneous abortion ( RR 0.88, 95% CI 0.38–1.99; P =0.750). Conclusions The use of amniotic membrane increased menstrual blood volume but failed to improve other measures assessed in the current meta‐analysis.