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Amnion graft following hysteroscopic lysis of intrauterine adhesions
Author(s) -
Amer Mohamed I.,
AbdElMaeboud Karim H.
Publication year - 2006
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2006.00454.x
Subject(s) - medicine , hysteroscopy , amnion , foley catheter , surgery , endometritis , adhesion , uterine perforation , perforation , catheter , pregnancy , population , fetus , chemistry , materials science , environmental health , organic chemistry , biology , family planning , metallurgy , punching , research methodology , genetics
Aim: To evaluate the safety and efficacy of amnion grafting after hysteroscopic lysis of intrauterine adhesions. Methods: In a pilot study involving 25 patients with moderate or severe intrauterine adhesions, hysteroscopic adhesiolysis was followed by intrauterine application of a fresh amnion graft over an inflated balloon of a Foley’s catheter for 2 weeks. Follow‐up hysteroscopy was performed after 4 months. Outcome measures included recurrence of adhesions, achievement of normal menstrual flow, and improvement in the uterine length. Results: Moderate (group A) and severe (group B) adhesions were found in 12 and 13 subjects, respectively. Uterine perforation occurred in two patients in group B, one treated conservatively and the other via laparoscopy. No clinical evidence of infection was observed, and spontaneous expulsion of the balloon occurred within days in three patients, with easy removal after 2 weeks in the rest of the subjects. Significant improvement in uterine length was found in both groups. Despite improvement, failure to achieve normal menstrual flow was found in 16.7% in group A versus 23.1% in group B. Follow‐up hysteroscopy revealed adhesion reformation in 48%, all belonging to group B, all with minimal adhesions. Moderate adhesions were found in only two subjects with previous tuberculous endometritis. Conclusion: Hysteroscopic lysis of intrauterine adhesions with amnion grafting seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration. Randomized comparative studies are needed to validate its benefits, including reproductive outcome.