Intrauterine synechiae after myomectomy
- Authors: Schukina N.A.1, Scherbatykh M.G.1, Babunashvili E.L.1, Bespalova A.G.1, Drobin O.Y.1, Zemskova N.Y.1, Glebov T.A.1, Kochetkova A.A.1
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Affiliations:
- Moscow Regional Research Institute of Obstetrics and Gynecology
- Issue: No 6 (2023)
- Pages: 134-140
- Section: Exchange of Experience
- URL: https://journals.eco-vector.com/0300-9092/article/view/562907
- DOI: https://doi.org/10.18565/aig.2023.124
- ID: 562907
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Abstract
Objective: To study the incidence of intrauterine synechiae in patients after myomectomy, to evaluate the effect of the antiadhesive enzyme bovhyaluronidase azoximer on their formation.
Materials and methods: A total of 160 patients with uterine fibroids who had been operated on in the Department of Operative Gynecology and Gynecological Oncology, and in the day hospital, Moscow Regional Research Institute of Obstetrics and Gynecology, were studied. This was a two-stage study (Stage 1 was a retrospective study of 80 patients after myomectomy; Stage 2 was an open-label prospective controlled study of 80 patients).
Results: The submucous localization of the nodes of uterine fibroids (0–2 types) is clinically unfavorable; its main manifestations are abnormal uterine bleeding (95%), pains (27.5%), infertility (45%), and anemia (60%). One of the causes of continuing infertility after myomectomy are intrauterine synechiae (46.1%) that are twice more often observed in patients after myomectomy of the nodes of 0–2 types (56.3%) than those of 3–7 types (30%). A prospective study, office hysteroscopy during the first two months after myomectomy) reveal that 18.5% the patients were found to have intrauterine synechiae. The main cause of their formation is dissection of the uterine cavity and damage to the endometrium when removing nodes of 0–2 types. In this period of time, all synechiae have a loose, delicate structure (organization type 1) and are easily destroyed by hydrodissection. The use of the enzyme bovhyaluronidase azoximer in the postoperative rehabilitation program after myomectomy can reduce the frequency of formation of intrauterine synechiae from 23.1 to 3.8% (p=0.03771).
Conclusion: Intrauterine synechiae form in every 5 patients after myomectomy of nodes of 0–2 types via through uterine cavity dissection of the uterine cavity after myomectomy of nodes of 0–2 types, by dissecting the uterine cavity, therefore it is expedient to include office hysteroscopy into the postoperative rehabilitation program for the patients (after 2 months). It is also advisable to incorporate long-acting hyaluronidase that reduces the frequency of formation of intrauterine synechiae into the postoperative rehabilitation program for reproductive-aged patients planning pregnancy after myomectomy of nodes of 0–2 types.
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About the authors
Natalya A. Schukina
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: fluimucil@yandex.ru
ORCID iD: 0000-0003-2274-4070
Dr. Med. Sci., Professor, Chief Researcher at the Department of Operative Gynecology with Oncogynecology and Day Hospital
Russian Federation, MoscowMarina G. Scherbatykh
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: marina.kaschchuk@yandex.ru
ORCID iD: 0000-0003-2679-3734
postgraduate student of the Department of Operative Gynecology with Oncogynecology and Day Hospital
Russian Federation, MoscowEvgenia L. Babunashvili
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: marina.kaschchuk@yandex.ru
ORCID iD: 0000-0002-3580-7221
PhD, Chief Researcher at the Department of Operative Gynecology with Oncogynecology and Day Hospital
Russian Federation, MoscowAnastasia G. Bespalova
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: bespalowa.nast@yandex.ru
ORCID iD: 0000-0003-1940-9001
obstetrician-gynecologist at the Department of Operative Gynecology with Oncogynecology and Day Hospital
Russian Federation, MoscowOleg Yu. Drobin
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: oleg_drobin@mail.ru
ORCID iD: 0000-0001-8707-3779
obstetrician-gynecologist
Russian Federation, MoscowNadezhda Yu. Zemskova
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: pasmurn@gmail.com
ORCID iD: 0000-0001-5460-0122
PhD, Researcher, Department of Ultrasound Diagnostics
Russian Federation, MoscowTimur A. Glebov
Moscow Regional Research Institute of Obstetrics and Gynecology
Author for correspondence.
Email: glebovt@mail.ru
ORCID iD: 0000-0001-6816-5360
postgraduate student of the Department of Operative Gynecology with Oncogynecology and Day Hospital
Russian Federation, MoscowAnna A. Kochetkova
Moscow Regional Research Institute of Obstetrics and Gynecology
Email: akochetkova1997@mail.ru
ORCID iD: 0009-0004-4403-9350
Resident
Russian Federation, MoscowReferences
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