THE INCIDENCE OF INTRAUTERINE ADHESIONS FOLLOWING POTENTIALLY ADHESIOGENIC PROCEDURES: A SYSTEMATIC LITERATURE REVIEW WITH META-ANALYSES
Author(s)
Coby Martin, MSc1, Rachel Gamburg, BSc2, Jatinder Kumar, MPharm3, Cheryl Jeffrey, BSc4, Malcolm G Munro, MD, PhD5, Christina Salazar, MD6, Bala Bhagavath, MD7, Mark Emanuel, MD8, Heather Huddleston, MD9, Angelo Hooker, MD, PhD10;
1Axtria Inc, Toronto, ON, Canada, 2Axtria Inc, Boston, MA, USA, 3Axtria India Pvt Ltd, RWE/HEOR/ES, Gurgaon, India, 4Rutgers University, New Brunswick, NJ, USA, 5David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 6Dell Medical School, University of Texas at Austin, Department of Women’s Health, TX, USA, 7University of Wisconsin-Madison, Department of Obstetrics & Gynecology, Madison, WI, USA, 8University Medical Center, Department of Gynecology and Reproductive Health, Utrecht, Netherlands, 9University of California, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, USA, 10Zaans Medical Center, Department of Obstetrics and Gynaecology, Zaandam, Netherlands
1Axtria Inc, Toronto, ON, Canada, 2Axtria Inc, Boston, MA, USA, 3Axtria India Pvt Ltd, RWE/HEOR/ES, Gurgaon, India, 4Rutgers University, New Brunswick, NJ, USA, 5David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 6Dell Medical School, University of Texas at Austin, Department of Women’s Health, TX, USA, 7University of Wisconsin-Madison, Department of Obstetrics & Gynecology, Madison, WI, USA, 8University Medical Center, Department of Gynecology and Reproductive Health, Utrecht, Netherlands, 9University of California, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, USA, 10Zaans Medical Center, Department of Obstetrics and Gynaecology, Zaandam, Netherlands
OBJECTIVES: Following uterine surgery, reproductive age women with intrauterine adhesions (IUAs) may experience irregularities in menstruation, infertility, preterm delivery, and/or peripartum hemorrhage. Despite several studies, understanding is limited regarding the true incidence and underlying causes of IUAs, given the varying risks associated with different surgical procedures and techniques. Herein, we investigated the incidence of IUAs to improve understanding of their causes.
METHODS: A systematic literature review (SLR) and meta-analysis (MA) was conducted to seek evidence on IUA occurrences following select uterine procedures on menstrual, endometrial, fertility, and pregnancy-related outcomes. The search was conducted in the PubMed, Embase, and Cochrane databases following PRISMA guidelines and included publications prior to November 8, 2024. MAs were conducted separately for randomized clinical trials (RCT) and non-RCT studies.
RESULTS: We extracted data from 34 studies and performed 5 MAs. The incidence of new onset IUAs varied based on the procedure and study type (RCT vs non-RCT incidence): 28% following septum correction (25% vs 31%), 16% post hysteroscopic myomectomy (32% vs 10%), 7% post abdominal myomectomy, 24% following removal of retained products of conception (RPOC) post-delivery, and 30% and 14% following evacuation of POC in the first trimester for RCT and non-RCT designs, respectively.
CONCLUSIONS: The risk of IUA development appears to vary between different types of surgical procedures performed. Certain procedures seem to carry high risk of IUA, such as septum correction or removal of RPOC post delivery, and may represent areas for improvement to prevent endometrial trauma and associated IUAs. Further, awareness of the relative risk associated with different procedures can guide surgical decision-making to help prevent IUAs and minimize long-term reproductive complications.
METHODS: A systematic literature review (SLR) and meta-analysis (MA) was conducted to seek evidence on IUA occurrences following select uterine procedures on menstrual, endometrial, fertility, and pregnancy-related outcomes. The search was conducted in the PubMed, Embase, and Cochrane databases following PRISMA guidelines and included publications prior to November 8, 2024. MAs were conducted separately for randomized clinical trials (RCT) and non-RCT studies.
RESULTS: We extracted data from 34 studies and performed 5 MAs. The incidence of new onset IUAs varied based on the procedure and study type (RCT vs non-RCT incidence): 28% following septum correction (25% vs 31%), 16% post hysteroscopic myomectomy (32% vs 10%), 7% post abdominal myomectomy, 24% following removal of retained products of conception (RPOC) post-delivery, and 30% and 14% following evacuation of POC in the first trimester for RCT and non-RCT designs, respectively.
CONCLUSIONS: The risk of IUA development appears to vary between different types of surgical procedures performed. Certain procedures seem to carry high risk of IUA, such as septum correction or removal of RPOC post delivery, and may represent areas for improvement to prevent endometrial trauma and associated IUAs. Further, awareness of the relative risk associated with different procedures can guide surgical decision-making to help prevent IUAs and minimize long-term reproductive complications.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO113
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
SDC: Injury & Trauma, SDC: Reproductive & Sexual Health, STA: Surgery