Reproductive outcomes in women with mild intrauterine adhesions; a systematic review and meta-analysis. 2022

Angelo B Hooker, and Floor J Mansvelder, and Roy G Elbers, and Zayel Frijmersum
Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam, The Netherlands.

Moderate to severe intrauterine adhesions (IUAs) may greatly impact fertility, predisposing to pregnancy and obstetric complications. The impact of mild IUAs on reproductive performance remains unclear. A systematic review and meta-analysis was performed to examine the long-term reproductive outcomes in women with hysteroscopic identified and treated mild IUAs mild intrauterine adhesions (IUAs). An electronic literature search was conducted using MEDLINE and EMBASE from inception to June 2019. All prospective cohort, cross-sectional studies or randomized controlled trials Clinical trials in which reproductive outcomes of women with mild IUAs, were reported were included. Five studies, reporting on reproductive outcomes of 229 women with hysteroscopic identified and treated mild IUAs, were included. The pregnancy rate was 62.3% (142 of 228; 95% CI: 0.55-0.72, I2 25%, p = .21) and in 86.6% (123 of 142) a live birth was encountered (95% CI: 0.71-0.97) with 83.1% (108 out of 130) term deliveries (95% CI: 0.53-0.95). A miscarriage was reported in 10% (13 of 130; 95% CI: 0.02-0.26). Due to the lack of a control group, reproductive outcomes were compared to a general population. Pregnancy and live birth rates were significantly lower in women with identified and treated mild IUAs, 90% versus 62.3% and respectively 99.5% versus 86.6%. The miscarriage rate was similar. Data on obstetric and neonatal outcomes are lacking. Women with hysteroscopic identified and treated mild IUAs seem to have lower pregnancy and live birth rate compared to the general population. Future studies consisting of a large cohort of women with hysteroscopic identified and treated IUAs with structural follow-up and a control group are needed to confirm our findings.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000022 Abortion, Spontaneous Expulsion of the product of FERTILIZATION before completing the term of GESTATION and without deliberate interference. Abortion, Tubal,Early Pregnancy Loss,Miscarriage,Spontaneous Abortion,Abortions, Spontaneous,Abortions, Tubal,Early Pregnancy Losses,Loss, Early Pregnancy,Losses, Early Pregnancy,Miscarriages,Pregnancy Loss, Early,Pregnancy Losses, Early,Spontaneous Abortions,Tubal Abortion,Tubal Abortions
D000267 Tissue Adhesions Pathological processes consisting of the union of the opposing surfaces of a wound. Adhesions, Tissue,Surgery-Induced Tissue Adhesions,Surgical Adhesions,Adhesion, Surgery-Induced Tissue,Adhesion, Surgical,Adhesion, Tissue,Adhesions, Surgery-Induced Tissue,Adhesions, Surgical,Surgery Induced Tissue Adhesions,Surgery-Induced Tissue Adhesion,Surgical Adhesion,Tissue Adhesion,Tissue Adhesion, Surgery-Induced,Tissue Adhesions, Surgery-Induced
D014591 Uterine Diseases Pathological processes involving any part of the UTERUS. Endometrial Diseases,Disease, Endometrial,Disease, Uterine,Diseases, Endometrial,Diseases, Uterine,Endometrial Disease,Uterine Disease
D015907 Hysteroscopy Endoscopic examination, therapy or surgery of the interior of the uterus. Endoscopy, Uterine,Hysteroscopic Surgical Procedures,Surgical Procedures, Hysteroscopic,Uterine Endoscopy,Hysteroscopic Surgery,Surgery, Hysteroscopic,Uteroscopy,Endoscopies, Uterine,Hysteroscopic Surgeries,Hysteroscopic Surgical Procedure,Hysteroscopies,Procedure, Hysteroscopic Surgical,Procedures, Hysteroscopic Surgical,Surgeries, Hysteroscopic,Surgical Procedure, Hysteroscopic,Uterine Endoscopies,Uteroscopies

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