Intrauterine synechiae after myomectomy
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.Shchukina N.A., Shcherbatykh M.G., Babunashvili E.L., Bespalova A.G., Drobin O.Yu., Zemskova N.Yu., Glebov T.A., Kochetkova A.A.
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.
Authors' contributions: Shchukina N.А. – scientific supervisor, writing the article; Shcherbatykh M.G. – material collection and processing; Babunashvili E.L. – material analysis and processing; Bespalova A.G. – surgical treatment; Drobin O.Yu. – writing the article; Zemskova N.Yu. – ultrasound study; Glebov T.A. – editing the article; Kochetkova A.A. – material analysis.
Conflicts of interest: The authors report that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The investigation has been approved by the local Ethics Committee, Moscow Regional Research Institute of Obstetrics and Gynecology.
Patient Consent for Publication: The patients have signed an informed consent form to publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Shchukina N.A., Shcherbatykh M.G., Babunashvili E.L., Bespalova A.G.,
Drobin O.Yu., Zemskova N.Yu., Glebov T.A., Kochetkova A.A.
Intrauterine synechiae after myomectomy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (6): 134-140 (in Russian)
https://dx.doi.org/10.18565/aig.2023.124
Keywords
intrauterine synechiae
myomectomy
infertility
office hysteroscopy
antiadhesive enzymes
bovhyaluronidase azoximer
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Received 17.05.2023
Accepted 07.06.2023
About the Authors
Natalya A. Schukina, Dr. Med. Sci., Professor, Chief Researcher at the Department of Operative Gynecology with Oncogynecology and Day Hospital, Moscow Regional Research Institute of Obstetrics and Gynecology, +7(903)594-19 -28, fluimucil@yandex.ru, https://orcid.org/0000-0003-2274-4070,101000, Russia, Moscow, Pokrovka str., 22a.
Marina G. Scherbatykh, postgraduate student of the Department of Operative Gynecology with Oncogynecology and Day Hospital, Moscow Regional Research Institute
of Obstetrics and Gynecology, +7(985)205-11-69, marina.kaschchuk@yandex.ru, https://orcid.org/0000-0003-2679-3734, 101000, Russia, Moscow, Pokrovka str., 22a.
Evgenia L. Babunashvili, PhD, Chief Researcher at the Department of Operative Gynecology with Oncogynecology and Day Hospital, Moscow Regional Research Institute
of Obstetrics and Gynecology, +7(915)239-46-34, marina.kaschchuk@yandex.ru, https://orcid.org/0000-0002-3580-7221, 101000, Russia, Moscow, Pokrovka str., 22a.
Anastasia G. Bespalova, obstetrician-gynecologist at the Department of Operative Gynecology with Oncogynecology and Day Hospital, Moscow Regional Research Institute
of Obstetrics and Gynecology, +7(925)883-13-76, bespalowa.nast@yandex.ru, https://orcid.org/0000-0003-1940-9001, 101000, Russia, Moscow, Pokrovka str., 22a.
Oleg Yu. Drobin, obstetrician-gynecologist, Health Clinical and Diagnostic Center, +7(918)561-19-83, oleg_drobin@mail.ru, https://orcid.org/0000-0001-8707-3779, 344011,Russia, Rostov-on-Don, per. Dolomanovsky, 70/3.
Nadezhda Yu. Zemskova, PhD, Researcher, Department of Ultrasound Diagnostics, Moscow Regional Research Institute of Obstetrics and Gynecology,
+7(903)776-59-86, pasmurn@gmail.com, https://orcid.org/0000-0001-5460-0122, 101000, Russia, Moscow, Pokrovka str., 22a.
Timur A. Glebov, postgraduate student of the Department of Operative Gynecology with Oncogynecology and Day Hospital, Moscow Regional Research Institute of Obstetrics and Gynecology, +7(916)120-11-45, glebovt@mail.ru, https://orcid.org/0000-0001-6816-5360, 101000, Russia, Moscow, Pokrovka str., 22a.
Anna A. Kochetkova, Resident, Moscow Regional Research Institute of Obstetrics and Gynecology, +7(909)948-87-67, akochetkova1997@mail.ru,
https://orcid.org/0009-0004-4403-9350, 101000, Russia, Moscow, Pokrovka str., 22a.
Corresponding author: Timur A. Glebov, glebovt@mail.ru
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