This study aims to investigate the treatment of intrauterine adhesion and the factors influencing its prognosis.
Intrauterine adhesion, also known as Asherman's syndrome, is the partial or complete occlusion of the uterine cavity as a result of endometrium damage. Most intrauterine adhesions patients manifest amenorrhea, reduced menstrual pattern, infertility, and intrauterine growth restriction, which seriously affect their reproductive health.It is well established that the formation of intrauterine adhesion likely involves hypoxia, reduced neovascularization, and altered expression of adhesion associated cytokines, but the exact mechanisms are not well understood. Although excessive curettage is considered the primary cause, intrauterine adhesion is known to be associated with diverse non-traumatic factors, such as postabortal sepsis, puerperal sepsis and infections. Intrauterine adhesion separation surgery is the gold standard for the treatment of uterine adhesion. Although the success rate is as high as 95%, the patients with moderate or severe uterine adhesion have severe damage to the endometrial basement, poor regeneration of endometrial and gland, poor tolerance of endometrial and poor clinical prognosis. Even if all kinds of anti-adhesion measures are used comprehensively, the postoperative recurrence rate of patients with moderate and severe uterine adhesion is high.Therefore this study was conducted to investigate whether intrauterine lavage or intrauterine gel-injection therapy after surgery could reduce the recurrence of intrauterine adhesion, promote the endometrial growth and repair and improve the menstruation and reproductive prognosis for severe intrauterine adhesion, and we hypothesize that intrauterine adhesion may be related to changes in microbial flora in the reproductive tract.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
Intrauterine lavage treatment was performed within 3 to 7 days after the first menstrual period after surgery.
Intrauterine gel-injection treatment was performed within 3 to 7 days after the first menstrual period after surgery.
Guangzhou
Guangdong, Guangzhou, Guangdong, China
RECRUITINGEndometrial Thickness of All Participants in the Mid Menstrual Measured by Color Doppler Ultrasound
Time frame: 1 year
Menstruation Pattern(Improvement or No Significant Change) of All Participants
A method similar to visual analogue scale(VAS) was employed for the evaluation of post-operative menstruation with 0 as amenorrhea and 100 as normal menstruation.
Time frame: 1 year
Reduction of American Fertility Society adhesion score at Second-look
The severity and extent of intrauterine adhesions were scored according to a classification system recommended by the American Fertility Society (AFS) (1988 version) \[7\]. A score of 1-4 was considered to represent mild adhesions, a score of 5-8 was considered to represent moderate adhesions and a score of 9-12 represented severe adhesions.
Time frame: one year
Number of Participants With Pregnancy after operation
Time frame: two years
Differences in distribution of reproductive tract bacteria between patients are before and after operation
Time frame: one year
Differences in distribution of reproductive tract bacteria between healthy control group and intrauterine adhesion patients
Time frame: one year
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