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Intrauterine Adhesions: Hysteroscopic Lysis and Adjunctive Methods
Author(s) -
Bellingham F. Richard
Publication year - 1996
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1996.tb03279.x
Subject(s) - medicine , uterine cavity , surgery , menstruation , hysterectomy , infertility , hysteroscopy , ultrasound , pregnancy , obstetrics , uterus , radiology , biology , genetics
EDITORIAL COMMENT: We accepted this paper for publication because the author describes a sophisticated method of dealing with adhesions under ultrasound control in those patients where the adhesions are dense. It is always difficult to assess the effectiveness of therapies used in the treatment of infertility especially as most studies do not have a control series. This comment may particularly apply to patients with minor adhesions that are divided by the passage of a hysteroscope. Summary: A series of 17 patients with significant intrauterine synechiae is presented with a demonstration of various adjunctive therapeutic measures which may be helpful. The procedure is ideally performed under ultrasound control and this is essential if the adhesions are extensive. There may be a place for postoperative use of an intrauterine contraceptive device or of hormone therapy, but these modalities are not universally accepted. However, 11 of 13 patients regained normal menstruation and 8 of the 10 desiring pregnancy achieved livebirths with these methods. Four of the latter had had severe adhesions. One patient (Case 9) was not seen after the postoperative visit (“lost to series‘) and 1 (Case 7) later had a hysterectomy for pain but the operative specimen showed a normal uterine cavity.