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Email this article Postoperative Management of Hysteroscopic Metroplasty of Congenital Uterine Anomalies Literature review
Abstract
Background: Successful implantation of the embryo and normal development of pregnancy after hysteroscopic metroplasty in women with congenital uterine anomalies, obtaining a normal endometrium is a necessary condition, which must be achieved by preventing development of postoperative intrauterine adhesions (IUA) and stimulating regeneration of the endometrium. Despite years of studies aimed at evaluating strategies to prevent IUA after operative hysteroscopy, it is still unclear which strategies are most effective.
Aim of the study: aim of the study is to review the literature data, analyze and evaluate advantages and disadvantages of therapeutic means used for prevention of development of IUA after hysteroscopic metroplasty and to stimulate the regeneration of the endometrium
Materials and methods: In order to collect literature data, we used such electronic search databases as PubMed, Medline, Google Scholar and Cochrane Library. Key words used were: "congenital uterine anomalies", "hysteroscopy", "metroplasty", "intrauterine adhesion", "anti-adhesion therapy", "endometrial regeneration".
Results: From 136 articles retrieved, we selected 62 articles and included them in our review. Analysis of selected literary sources revealed that use of mechanical barriers against IUA in postoperative period does not provide additional positive benefits in terms of reduction of spontaneous abortions, development of spontaneous pregnancy and increase of the rate of live birth. Their role in reducing development of IUA is also controversial. Also, use of mechanical barriers in combination with estrogen therapy did not show reliably high results in terms of improving female reproductive function. Regarding positive therapeutic effect of anti-adhesion gels, by analyzing reviewed literature sources, we obtained contradictory results. As for the effectiveness of using anti-adhesion gels with estrogen therapy after metroplasty, postoperative treatment with similar combination could not be seen in the literature sources. It should be noted that available literature has significant heterogeneity and a high risk of bias, which makes it difficult to draw final conclusions and does not allow for elaboration of optimal postoperative management scheme.
Conclusion: Based on the analysis of literature sources it is clear that more research is needed to evaluate effectiveness of different anti-adhesion means both as monotherapy and in combination.
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