Adverse Pregnancy Outcomes Following Intrauterine Adhesiolysis - A Systematic Review

Study Objective

Adverse pregnancy outcomes following intrauterine lysis of adhesions have been reported. The objective was to perform a meta-analysis of published research to quantify the risk.

Design

Systematic review.

Setting

International, multi-institutional collaboration.

Patients or Participants

Using search terms including intrauterine adhesions, surgery, and clinical outcomes, Cochrane, Embase and PubMed databases were systematically searched without any date limits. Very few randomized controlled trials were found pertaining to this assessment and hence meta-analysis could not be performed. Therefore, observational studies were included to perform a systematic review.

Interventions

Hysteroscopic adhesiolysis.

Measurements and Main Results

2214 abstracts were identified and 418 assessed for eligibility. 235 studies were found to be eligible and 18 were eventually included in the analysis. Preterm delivery rate was 17%. Placental abnormalities included 11% placenta acreta spectrum disorders and 3% previa. Antepartum hemorrhage occurred in 3% and Peripartum hemorrhage in 10%. Hysterectomy was performed in 4%.

Conclusion

Hysteroscopic lysis was adhesions is associated with adverse events during subsequent pregnancies. High quality studies are needed to better assess the impact of intrauterine adhesiolysis on pregnancy outcomes.