Dynamic perioperative inflammatory biomarkers predict intrauterine adhesion formation following hysteroscopic myomectomy: a prospective cohort study.

BACKGROUND

Intrauterine adhesions (IUAs) are a common complication following hysteroscopic submucosal myomectomy and are closely linked to impaired endometrial healing. The role of perioperative inflammatory biomarkers in predicting adhesion formation remains incompletely defined.

METHODS

This prospective cohort study included 140 women undergoing hysteroscopic submucosal myomectomy at a tertiary care center between April 2024 and October 2025. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) were measured preoperatively, at 48 h, and at 12 weeks postoperatively. IUAs were assessed by second-look hysteroscopy and graded according to American Fertility Society criteria. Multivariable logistic regression and correlation analyses were performed to identify predictors of adhesion formation.

RESULTS

IUAs developed in 42 patients (30.0%). Baseline characteristics were comparable between groups; however, FIGO type II fibroids and longer operative time were significantly associated with adhesion formation (p < 0.05). At 48 h postoperatively, IL-6 and CRP levels were significantly higher in the IUA group compared to the non-IUA group (both p < 0.001), while TNF-α showed a smaller increase. IL-6 demonstrated the strongest correlation with adhesion severity (ρ = 0.54, p < 0.001), followed by CRP (ρ = 0.46, p < 0.001). In multivariable analysis, IL-6 (adjusted OR = 1.24, 95% CI: 1.10-1.40) and CRP (adjusted OR = 1.31, 95% CI: 1.07-1.60) were independent predictors of moderate-to-severe IUAs, whereas TNF-α was not significant.

CONCLUSION

Perioperative inflammatory response, particularly elevated IL-6 and CRP levels, is strongly associated with intrauterine adhesion formation following hysteroscopic myomectomy. Early postoperative biomarker assessment may provide a valuable strategy for risk stratification and targeted prevention of IUAs.