Determinants of uterine synechiae at hysteroscopy: a case-control study in Kinshasa, Democratic Republic of Congo.

In most cases, synechiae originate from traumatic uterine procedures in a gravid or non-gravid uterus. The aim of this study was to identify determinants of uterine synechiae in a population of Kinshasa. A case-control study was conducted at the Endo-conception Clinic in Kinshasa, DRC, from March 1st, 2018, to February 28th, 2023. Cases were patients with uterine synechiae in hysteroscopy, and controls were patients with normal hysteroscopy. The comparison of proportions was made using the Pearson Chi-square test and Fisher's Exact. The student's t-test was used to compare means whose variables were normally distributed and the comparison of the medians of parity and gravidity was made with the U Mann-Whitney test. The test was significant for a p-value < 0.05. A total of 223 patients with synechiae (cases) and 472 patients with normal hysteroscopy (controls) were collected. The mean age was 38.41 years ± 6.60 for cases and 36.91 years ± 6.86 for controls. Comparing cases to controls, history of curettage was present in 69.1% versus 37.3 %, history of uterine surgery in 58.7% versus 35.6% and dysmenorrhea in 17.9% versus 8.9%. Factors associated with uterine synechiae were dysmenorrhea (aOR: 2.51, 95% CI 1.54 - 4.19; p=0.000), history of curettage (aOR: 3.32, 95% CI 1.97 - 5.60; p = 0.000) and uterine surgery (aOR: 2.96, 95% CI 2.08 - 4.21; p = 0.000). The findings demonstrate a notable frequency of uterine synechiae in patients with a history of curettage, uterine surgeries, and dysmenorrhea in cases compared to controls, identifying them as determinants of the condition.