The efficacy of early office hysteroscopy in preventing intrauterine adhesions after abortion: a randomized controlled trial

• Published in: BMC women's health 2024-07, Vol.24 (1), p.400-8, Article 400
• Main Authors: Tsai, Ni-Chin, Hsiao, Yu-Yang, Su, Yu-Ting, Lin, Yu-Ju, Kung, Fu-Tsai, Chen, Ping-Ho, Lan, Kuo-Chung
• Format: Article
• Language: English
• Subjects: Abortion; Abortion, Induced - adverse effects; Abortion, Induced - methods; Adhesion; Adhesions; Adult; Clinical trials; Complications; Complications and side effects; Dilatation and Curettage - adverse effects; Dilatation and Curettage - methods; Female; Fertility; Fertility outcome; Humans; Hysteroscopy; Hysteroscopy - adverse effects; Hysteroscopy - methods; Induced abortion; Infertility; Intrauterine adhesions; Menstruation; Methods; Middle Aged; Patients; Pregnancy; Prevention; Prospective Studies; Suction dilatation and curettage; Suctioning; Surgery; Testing; Tissue Adhesions - prevention & control; Uterine Diseases - diagnosis; Uterine Diseases - prevention & control; Uterine Diseases - surgery; Young Adult
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-024-03247-0

Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .