title: Etiology, treatment, and reproductive prognosis of women with moderate-to-severe intrauterine adhesions.
abstract: OBJECTIVE
  To analyze data from the hysteroscopic adhesiolysis of moderate-to-severe intrauterine adhesions (IUAs), and to review the disease etiology, changes in menstruation, uterine recovery, and reproductive prognosis of women after comprehensive therapy.
  
  
  METHODS
  In a retrospective descriptive analysis, clinical data were assessed from 683 patients with moderate-to-severe IUAs who were treated by hysteroscopic adhesiolysis at Third Xiangya Hospital, Changsha, China, between January 2007 and December 2011. Patients underwent comprehensive treatment. After hysteroscopic adhesiolysis, a persistent balloon urinary catheter was inserted, together with an intrauterine device (IUD). Intrauterine sodium hyaluronate gel was injected to prevent adhesion reformation, and oral estrogen was administered to promote endometrial regeneration. The outcomes were menstrual changes and uterine recovery under hysteroscopy, and the reproductive prognosis of patients with fertility intentions.
  
  
  RESULTS
  At the 3-month follow-up, the postoperative recovery of uterine shape was better than the recovery of menstruation among patients with moderate-to-severe IUAs. Among the 475 patients with fertility intentions, the pregnancy and live birth rates were 66.1% (314/475) and 64.0% (201/314), respectively.
  
  
  CONCLUSIONS
  Comprehensive treatment prevented the recurrence of IUAs to a certain extent, but some severe endometrial injuries were found to be irreparable, reducing the rate of subsequent pregnancy and live birth.
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Songshu
authors.initials: S
authors.lastname: Xiao
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China. Electronic address: 287932636@qq.com.
authors.forename: Min
authors.initials: M
authors.lastname: Xue
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Zeng
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Xiao
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Dabao
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Pu
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Sheng
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Junlei
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Sai
authors.initials: S
authors.lastname: Zhou
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D020878:Device Removal / Q000009:adverse effects; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015907:Hysteroscopy; D007434:Intrauterine Devices; D050498:Live Birth; D008598:Menstruation / Q000502:physiology; D011247:Pregnancy; D018873:Pregnancy Rate; D020127:Recovery of Function; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000209:etiology / Q000628:therapy; D014376:Tuberculosis / Q000150:complications; D058738:Uterine Balloon Tamponade; D014591:Uterine Diseases / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid
keywords: Comprehensive treatment; Hysteroscopic adhesiolysis; Intrauterine adhesions