Hysteroscopic Adhesiolysis for Intra-Uterine Adhesions: Implications and Limitations in a Low Resource Setting

Okagua, Kenneth Eghuan *

Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 4-6 Harley Street, Old GRA, Port Harcourt, Nigeria.

Ela, George Mathew

Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 4-6 Harley Street, Old GRA, Port Harcourt, Nigeria.

*Author to whom correspondence should be addressed.


Abstract

Background: The advent of hysteroscopy has radically changed the treatment modality for intra-uterine adhesion (IUA) which is a challenge for women of reproductive age, causing menstrual abnormalities and infertility and occurring in about 1.5% of the general population. Hysteroscopic techniques are now considered the gold standard for the treatment of IUA but it is unfortunately neither readily accessible nor affordable in resource poor settings.

Aim: To present the efficacy of this treatment modality and advocate for its popularization in resource poor settings.

Case Report: A 38-year-old housewife, P2+1(2 alive, 2 previous caesarean sections), presented with features of IUA and 6 months amenorrhoea following dilatation and curettage (D&C) for a blighted ovum. She had hysteroscopic adhesiolysis, Foleys catheter insertion and hormonal therapy. Resumption of menstruation occurred within one month of the procedure and post operative investigation results suggests a capacious uterine cavity.

Conclusion: Hysteroscopy is the way forward in the treatment of IUAs instead of the traditional method of blind D&C but advocacy is needed to bring it within the reach of women in resource poor settings.

Keywords: Hysteroscopy, adhesiolysis, intrauterine adhesions, resource poor


How to Cite

Eghuan , O. K., & Mathew , E. G. (2024). Hysteroscopic Adhesiolysis for Intra-Uterine Adhesions: Implications and Limitations in a Low Resource Setting . International Journal of Research and Reports in Gynaecology, 7(1), 1–5. Retrieved from https://journalijrrgy.com/index.php/IJRRGY/article/view/93

Downloads

Download data is not yet available.

References

Hooker A, Fraenk D, Brolmann H, Huirne J. Prevalence of Intrauterine Adhesions after termination of pregnancy: A systematic review. Eur J Contracept Reprod Health Care 2016;21(4):329-35.

Usman SF, Efetie ER, Ibraheem RS, Katagum D, Ladipo OP. The scope of hysteroscopy in the diagnosis and management of intrauterine conditions at a public fertility center in north-central Nigeria: A retrospective study. Afr J Reprod Gynaecol Endosc. 2022;7:11-6.

Okohue JE. The role of assisted operative hysteroscopy in ashermans management. In: Manchanda R(ed). Intra uterine adhesions: Diagnostic and therapeutic insight. Singapore: Springer Nature Singapore Pte. 2021;123-135.

Orhue AAE, Aziken ME, Eigbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynecol Obstet. 2003;82:49-56.

Hegazy RA, Hegazy AA, Etman WM. Tubo-ovarian actinomycosis in perimenopausal woman with neglected intrauterine device: A case report and review of literature. J Medical Case Report. 2021;3(4):1-5.

Pacheco LA, Carugno J, Timmons D, Sanchez MG. Complications and fertility potential following adhesiolysis. In: Manchanda R(ed). Intra uterine adhesions: Diagnostic and therapeutic insight. Singapore: Springer Nature Singapore Pte. 2021;173-184

Kalu E, Nzeribe E, Nzurumike C. Complications associated with hysteroscopic surgery. In: J.E. Okohue et al. (eds). Gynaecological Endoscopic Surgery. Switzerland: Springer Nature Switzerland AG. 2022;327-337.

Hadisaputra W, Hani CA, Putri NA. Patient safety in hysteroscopic procedure. Gynecol Minim Invasive Ther. 2022;11:145-9.

Dogra Y, Singh N, Vanamail P. Autologous platelet-rich plasma optimizes endometrial thickness and pregnancy outcomes in women with refractory thin endometrium of varied aetiology during fresh and frozen-thawed embryo transfer cycles. JBRA Assist Reprod. 2022;26(1):13-21.

Puente Gonzalo E, Alonso Pacheco L, Vega Jimenez A, Vitale SG, Raffone A, Lagana AS. Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: A cutting-edge approach. Updates Surg. 2021;73(6):2355-2362.

Owhonda G, Eli S, Okagua KE, Ocheche U, Dan-Jumbo A, Nonye-Enyindah E, et al. Perception prevalence of the relationship between PID and infertility amongst women of reproductive age: A Nigerian Study. International Journal of Life Science Research Archive 2023;04(01): 138-142.