Meta-analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis.

BACKGROUND

Various adjuvant therapies have failed to improve clinical symptoms and pregnancy rates among patients with moderate-to-severe intrauterine adhesion.

OBJECTIVES

To evaluate the ability of amniotic membrane to prevent the recurrence of intrauterine adhesion after hysteroscopic adhesiolysis.

SEARCH STRATEGY: The Cochrane Library, Embase, and PubMed databases were searched for articles published before December 31, 2017, using the terms: ("amnion") and ("intrauterine adhesions" or "Asherman syndrome" or "IUA" or "endometrial injury" or "uterine adhesion" or "hysteroscopic" or "hysteroscopic adhesiolysis").

SELECTION CRITERIA: Randomized controlled trials of amniotic membrane therapy after hysteroscopic adhesiolysis.

DATA COLLECTION AND ANALYSIS: Four studies were included in the meta-analysis (300 patients in total). Dichotomous outcomes were expressed as relative risk (RR) with 95% confidence intervals (CIs). Continuous variables were expressed as mean difference.

MAIN

RESULTS

Amniotic membrane increased menstrual blood volume after hysteroscopic adhesiolysis (mean difference 6.15, 95% CI 4.20-8.11; P<0.001). By contrast, this treatment did not affect the rates of intrauterine adhesion recurrence (RR 0.84, 95% CI 0.61-1.16; P=0.290); pregnancy (RR 1.40, 95% CI 0.78-2.50; P=0.260); or spontaneous abortion (RR 0.88, 95% CI 0.38-1.99; P=0.750).

CONCLUSIONS

The use of amniotic membrane increased menstrual blood volume but failed to improve other measures assessed in the current meta-analysis.