Pregnancy outcome following treatment of intrauterine adhesions

Intrauterine adhesions resulting from endometrial trauma during or shortly after pregnancy have been shown to be a cause of subsequent reproductive difficulty. Spontaneous abortion, premature delivery, abnormal presentation of the fetus, and abnormal implantation of the placenta, as well as secondary infertility, reduced or absent menstrual flow, and pelvic pain have all been associated with intrauterine adhesions. The extent of adhesion formation prior to therapy has been thought to be related to the prognosis for return of normal menstrual function and successful pregnancy outcome. Several classification systems have been proposed. The present study was undertaken to evaluate the usefulness of a classification system to predict the degree of menstrual dysfunction and subsequent pregnancy outcome. An historical prospective analysis was made of 25 patients. The extent of intrauterine adhesion formation was categorized according to the classification suggested by Toaff and Ballas. The assignment for classification was based on an estimate of the area involved in adhesion formation according to the appearance of the hysterogram. Adhesions were suspected when intrauterine-filling defects were seen (Figs. 1 to 4). The presence of intrauterine adhesions was confirmed at the time of definitive therapy. The clear majority of patients presented with repeated pregnancy loss. Most of them had Grade I or Grade II disease, i.e., one-tenth to one-fifth of the cavity was occupied by filling defects (Table 1). Only six patients had one-third or more of the uterine cavity obliterated. Nineteen patients in this series reported normal menses. Of the six patients with altered menses, none had Grade III or Grade IV intrauterine adhesion formation. In fact, a majority of patients with altered menstrual function were found to have Grade I disease. A correlation between severity of intrauterine adhesion formation and diminishing or absent menstrual flow could not be established.