Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery?

Authors

  • LUCIE HRAZDIROVA,

    1. Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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  • KAMIL SVABIK,

    1. Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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  • ZDENEK ZIZKA,

    1. Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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  • ANNA GERMANOVA,

    1. Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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  • DAVID KUZEL

    1. Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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  • Please cite this article as: Hrazdirova L, Svabik K, Zizka Z, Germanova A, Kuzel D. Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery?Acta Obstet Gynecol Scand 2012;91: DOI:10.1111/j.1600-0412.2011.01338.x.

Lucie Hrazdirova, Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University in Prague, Apolinarska 18, 128 51 Prague 2, Czech Republic. E-mail: lucie.hra@seznam.cz

Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Abstract 

We investigated the frequency of pathology, especially intrauterine adhesions, after instrumental evacuation within 24 h of delivery in a prospective observational intervention study on 100 women where a ‘see and treat’ hysteroscopy was performed after three to four months. There were two possible etiology groups: intrauterine adhesions [classified according by European Society for Gynaecological Endoscopy (ESGE) grades I–IV] and residual tissue (classified as minimal and considerable). Adhesions were found in 18% of patients, as follows: ESGE I–II in 13% and ESGE III–IV in 5%. Residual tissue was present in 33%, as follows: minimal in 23% and considerable in 10%. There were 6% who had both mild adhesions and minimal residual tissue, while 43% of the women had normal intrauterine findings. Of the women, 32% were symptomatic (spotting, bleeding). Only residual tissue correlated with symptoms (r=0.376; p<0.001). There is a high prevalence of acquired intrauterine pathology (57%) in women who require early instrumental evacuation.

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