RISK FACTORS AND MANAGEMENT OUTCOME OF INTRAUTERINE ADHESION IN A CONSTRAINED SOCIO-ECONOMIC ENVIRONMENT: A 10-YEAR REVIEW IN THE UNIVERSITY OF CALABAR TEACHING HOSPITAL, CALABAR

Charles Njoku, Cajethan Emechebe*, Edu Eyong, Boniface Ago and John Ekabua

ABSTRACT

Background: Intrauterine adhesion remains an important cause of menstrual abnormalities and infertility in our environment. Objectives: This study was undertaken to review the risk factors and management outcome of intrauterine adhesion in our hospital. Methods: This retrospective cross-sectional study of cases of intrauterine adhesion managed at UCTH, Calabar was carried out over a 10‑year period, from January 1, 2005 to December 31, 2014. The data were analyzed using the Gold Stat Pac software packages Statpac Inc. Minneapolis, USA and presented in tables in simple percentages. Results: Intrauterine adhesion constituted 3.2% of all gynecological operations during the study period. Most patients belonged to age group of 30-34 (43.6%); para 1-2 (50.0%); married (77.4%) and with secondary education (48.4%). The common risk factors were history of termination of pregnancy/incomplete abortion (33.9%) and puerperal sepsis (12.9%). Hypomenorrhea and infertility were the most common mode of presentations in 58.1% and 54.8% of cases respectively. All the patients managed over the period had dilatation and blind adhesiolysis under anaesthesia and restoration of normal menstruation was achieved in 48.4% of the patients while the pregnancy rate was 29.0%. Conclusion: Intrauterine adhesion is relatively common due to complications of pregnancy and delivery. Therefore, prevention includes provision of contraceptive advice and early evacuation of products of conception with manual vacuum aspiration (MVA) with care where uterine curettage must be done. Also, hysteroscope and training should be made available for hysteroscopic adhesiolysis for better treatment outcome.

Keywords: intrauterine adhesion, infertility, asherman’s syndrome, amenorrhoea, Calabar.