title: Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery?
abstract: We investigated the frequency of pathology, especially intrauterine adhesions, after instrumental evacuation within 24 h of delivery in a prospective observational intervention study on 100 women where a 'see and treat' hysteroscopy was performed after three to four months. There were two possible etiology groups: intrauterine adhesions [classified according by European Society for Gynaecological Endoscopy (ESGE) grades I-IV] and residual tissue (classified as minimal and considerable). Adhesions were found in 18% of patients, as follows: ESGE I-II in 13% and ESGE III-IV in 5%. Residual tissue was present in 33%, as follows: minimal in 23% and considerable in 10%. There were 6% who had both mild adhesions and minimal residual tissue, while 43% of the women had normal intrauterine findings. Of the women, 32% were symptomatic (spotting, bleeding). Only residual tissue correlated with symptoms (r=0.376; p<0.001). There is a high prevalence of acquired intrauterine pathology (57%) in women who require early instrumental evacuation.
authors.affiliation: Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic. lucie.hra@seznam.cz
authors.forename: Lucie
authors.initials: L
authors.lastname: Hrazdirova
authors.forename: Kamil
authors.initials: K
authors.lastname: Svabik
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Zizka
authors.forename: Anna
authors.initials: A
authors.lastname: Germanova
authors.forename: David
authors.initials: D
authors.lastname: Kuzel
mesh_terms: D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D018457:Placenta, Retained / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000175:diagnosis; D014591:Uterine Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology