Chitosan combined with intrauterine device prevents intrauterine adhesions after hysteroscopic adhesiolysis: A target trial emulation study.
J Obstet Gynaecol Res
; 49(6): 1571-1578, 2023 Jun.
Article
em En
| MEDLINE
| ID: mdl-36869641
ABSTRACT
AIM:
To compare the efficacy of chitosan and intrauterine device (IUD) combination with an IUD alone in patients with intrauterine adhesions (IUAs) who underwent hysteroscopic adhesiolysis.METHODS:
This retrospective study assessed 303 patients with moderate-to-severe IUA (American Fertility Society [AFS] score ≥5) who underwent hysteroscopic adhesiolysis between January 2018 and December 2020. Using observational data under a cohort design, we emulated a target trial with two treatment arms chitosan plus IUD and IUD alone groups. Second-look hysteroscopy was performed in all patients 3 months after the initial hysteroscopy. The primary outcome was improved adhesion assessed using the AFS scoring system.RESULTS:
The baseline characteristics were balanced between the two groups. The second hysteroscopy revealed significantly better AFS scores in group A than in group B (values 3 [1-4] vs. 4 [2-6], p < 0.001; change 63% [50%-80%] vs. 44% [33%-67%], p < 0.001, respectively). Significantly better menstruation conditions (improved rate 66% vs. 49%, p = 0.004) and endometrial thickness (mean 7.0 mm vs. 6.0 mm, p < 0.001) were also observed in group A than in group B. Moreover, group A showed a significantly higher 1-year clinical pregnancy rate (40% vs. 28%, p = 0.037) and better quality of life (p < 0.001) than group B.CONCLUSIONS:
Chitosan and IUD combination showed better efficacy in reducing adhesions and improving clinical outcomes in patients with moderate-to-severe IUA after hysteroscopic adhesiolysis.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Etiology_studies
/
Observational_studies
Limite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article