Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Jude E. Okohue, Nkeiruka Ameh, Adebayo Adewole


Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352–4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended. (Afr J Reprod Health 2022; 26[12]: 90-96).

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Smikle C, Yarrarapu SNS and Khetarpal S. Asherman

syndrome. In: StatPearls [Internet]. Treasure Island

(Florida): StarPearls Publishing. 2021[cited 2020

Dec 14]. Available from:

Dreisler E and Kjer JJ. Asherman’s syndrome: current

perspectives on diagnosis and management. Int J

Womens Health. 2019;11:191–8.

Asherman JG. Amenorrhoea traumatica (atretica). J Obstet

Gynaecol Br Emp. 1948;55:23–30.

Hanstede MM, van der Meij E, Goedemans L and Emanuel

MH. Results of centralized Asherman surgery, 2003–

Fertil Steril. 2015;104:1561–8.e1.

March CM. Asherman’s syndrome. Semin Reprod Med.


Rasheed SM, Amin MM, Abd Ellah AH, Abo Elhassan AM,

El Zahry MA and Wahab HA. Reproductive

performance after conservative surgical treatment of postpartum hemorrhage. Int J Gynaecol Obstet.


Bankole A, Adewole IF, Hussain R, Awolude O, Singh S

and Akinyemi JO. The incidence of abortion in

Nigeria. Int Perspect Sex Reprod Health.


Enabudoso EJ, Gharoro EP, Ande ABA, Ekpe UP and

Okohue E. Five year review of complicated induced

abortions in university of Benin teaching hospital,

Benin City. Benin Journal of Postgraduate Medicine.


Okohue JE, Ameh N, Onuh SO and Madugu NH. A

retrospective review of the outcome of abdominal

myomectomies at a Fertility Centre in South–South

Nigeria. West Afr J Med. 2021;38:526–30.

Conforti A, Krishnamurthy GB, Dragamestianos C,

Kouvelas S, Micallef Fava A, Tsimpanakos I, Magos

A. Intrauterine adhesions after open myomectomy:

an audit. Eur J Obstet Gynecol Reprod Biol.


Okohue JE, Okohue JO. Establishing a low-budget

hysteroscopy unit in a resource-poor setting. Gynecol

Minim Invasive Ther. 2020;9:18–23.

March CM, Israel R and March AD. Hysteroscopic

management of intrauterine adhesions. Am J Obstet

Gynecol. 1978;130:653–7.

Moore JF and Carugno J. Hysteroscopy. In: StatPearls

[internet]. Treasure Island (Florida): StartPearls

Publishing; 2022. Cited 2022 Dec 27. Available



Hooker AB, Lemmers M, Thurkow AL, Heymans MW,

Opmeer BC, Brölmann HA, Mol BW and Huirne JA.

Systematic review and meta-analysis of intrauterine

adhesions after miscarriage: prevalence, risk factors

and long-term reproductive outcome. Hum Reprod

Update. 2014;20:262–78.

Schenker JG and Margalioth EJ. Intrauterine adhesions: an

updated appraisal. Fertil Steril. 1982;37:593–610.

Ugboaja JO, Oguejiofor C and Igwegbe AO. Clinicohysteroscopic analysis of severe intrauterine

adhesions among Nigerian infertile women. Pan Afr

Med J. 2017;28:226.

Papoutsis D, Georgantzis D, Daccò MD, Halmos G,

Moustafa M, Mesquita Pinto AR and Magos A. A

rare case of Asherman’s syndrome after open

myomectomy, sonographic investigations and

possible underlying mechanisms. Gynecol Obstet

Invest 2014;77:194–200.

Geidam AD, Lawan ZM, Chama C and Bako BG.

Indications and outcome of abdominal myomectomy

in University of Maiduguri Teaching Hospital.

Review of ten year. Niger Med J. 2011;52:193–7.

Friedler S, Margalioth EJ, Kafka I and Yaffe H. Incidence

of post-abortion intra-uterine adhesions evaluated by

hysteroscopy – a prospective study. Hum Reprod.


Gilman Baber AR, Rhone SA and Fluker MR. Curettage

and Asherman’s syndrome—lessons to (re-) learn? J

Obstet Gynaecol. 2014;36:997–1001.

Xu W, Zhang Y, Yang Y, Zhang S and Lin X. Effect of

early second-look hysteroscopy on reproductive

outcomes after hysteroscopic adhesiolysis in patients

with intrauterine adhesion, a retrospective study in

China. Int J Surg. 2018;50:49–54.

Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G and

Singh N. Reproductive outcome following

hysteroscopic adhesiolysis in patients with infertility

due to Asherman’s Syndrome. Arch Gynecol Obstet.


Yang L, Wang L, Chen Y, Guo X, Miao C, Zhao Y, Li L

and Zhang Q. Cold scissors versus electrosurgery for

hysteroscopic adhesiolysis: A meta-analysis. Med

(Baltim). 2021;100:e25676.

Goetzl LM and ACOG Committee on Practice Bulletins –

Obstetrics. ACOG practice bulletin clinical

management guideline for obstetriciangynaecologists. Obstetric analgesia and anaesthesia.

Obstet Gynecol. 2002;100;36:177–91.

Claeys J, Hellendoorn I, Hamerlynck T, Bosteels J and

Weyers S. The risk of uterine rupture after

myomectomy: a systematic review of the literature

and meta-analysis. Gynecol Surg. 2014;11:197–206.

Nahum GG and Quynh PK. Uterine rupture in pregnancy

[Internet]. 2018 Medscape Reference. [cited 2020

Dec 19]. Available from: http://reference


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