POST-OPERATIVE ADJUNCTIVE TREATMENT OPTIONS IN PATIENTS WITH INTRAUTERINE ADHESIONS AND RECOMMENDATIONS FOR THE FUTURE: A SYSTEMATIC REVIEW

Objectives Intrauterine adhesions (IUAs) may lead to clinical sequelae such as miscarriage, infertility, and menstruation irregularities. Hysteroscopy is recognized as the gold standard in diagnosis and management, though the optimal course of treatment after surgical intervention remains unclear. The aim of our systematic review is to provide an update on the treatment options available post-hysteroscopic adhesiolysis and to facilitate clinical management of patients with IUAs. Methods To avoid duplicating previous work, we focused only on studies which compared hormone therapy and other post-operative treatments. We reviewed the use of adjunctive treatments, such as hormone therapy, aspirin, intrauterine device, balloon catheter, hyaluronic acid gel, and amnion graft and limited our review to randomized controlled trials and cohort studies. Results Of 548 studies published between 2013 and 2018, 15 papers fit our criteria that compared post-resection treatment options in women with IUAs. Meta-analysis of the use of Foley catheter or amnion graft as an adjunctive therapy post-adhesiolysis failed to show a statistical difference (OD 1.55; 95% CI 0.60-3.99). Meta-analysis could not be done for the 13 remaining studies due to extensive heterogeneity, bias, or non-comparable end points. Conclusions The lack of a universal classification system for IUAs and the use of variable outcomes to measure the success of adjunctive treatment pose a challenge in generating standard treatment recommendations. We call for the development of a universal classification system and studies with consistent parameters and endpoints to allow for the generation of standard treatment guidelines. Currently, it is impossible to recommend any standardized treatment after hysteroscopic adhesiolysis. Intrauterine adhesions (IUAs) may lead to clinical sequelae such as miscarriage, infertility, and menstruation irregularities. Hysteroscopy is recognized as the gold standard in diagnosis and management, though the optimal course of treatment after surgical intervention remains unclear. The aim of our systematic review is to provide an update on the treatment options available post-hysteroscopic adhesiolysis and to facilitate clinical management of patients with IUAs. To avoid duplicating previous work, we focused only on studies which compared hormone therapy and other post-operative treatments. We reviewed the use of adjunctive treatments, such as hormone therapy, aspirin, intrauterine device, balloon catheter, hyaluronic acid gel, and amnion graft and limited our review to randomized controlled trials and cohort studies. Of 548 studies published between 2013 and 2018, 15 papers fit our criteria that compared post-resection treatment options in women with IUAs. Meta-analysis of the use of Foley catheter or amnion graft as an adjunctive therapy post-adhesiolysis failed to show a statistical difference (OD 1.55; 95% CI 0.60-3.99). Meta-analysis could not be done for the 13 remaining studies due to extensive heterogeneity, bias, or non-comparable end points. The lack of a universal classification system for IUAs and the use of variable outcomes to measure the success of adjunctive treatment pose a challenge in generating standard treatment recommendations. We call for the development of a universal classification system and studies with consistent parameters and endpoints to allow for the generation of standard treatment guidelines. Currently, it is impossible to recommend any standardized treatment after hysteroscopic adhesiolysis.