Objective
Intrauterine
adhesions (IUAs) are the major long-term complications of operative
hysteroscopy(OH). It may result in poor reproductive outcomes, menstrual
abnormalities and pelvic pain. Several methods have been tried to
prevent post-surgical IUAs but all without significant benefits. Moist
exposed burn ointment (MEBO) is a herbal product, containing
phytosterols with anti-inflammatory, anti-bacterial and analgesic
effects mainly used for wound healing and management of burns and
ulcers, such properties might be useful to avoid IUAs, therefore, aim of
this study is to assess the efficacy and safety of MEBO in prevention
of de novo IUAs following OH.
Design
A randomized controlled University hospitals-based study.
Materials and Methods
Selected
72 patients during a period of 12 months were enrolled in this study.
Inclusion criteria: hysteroscopic diagnosis of submucous myomas, polyps,
uterine septa or DUB requiring endometrial resection. Exclusion
criteria were: age > 50, obesity, pregnancy, prolapse, malignancy,
and presence of IUAs. Patients were randomized into 2 groups, and
without significant differences in age, weight, uterine size and party.
Group (A) of 40 patients underwent hysteroscopic surgery(HS) plus
intrauterine application of MEBO. Group (B), the remaining 32 patients,
underwent (HS) only (control). Follow-up diagnostic hysteroscopy was
performed for each patient, 6 weeks later. Adhesion score assessment
according to the American Fertility Society (AFS) classification system.
Statistical analysis performed using SPSS package. P-value considered
to be significant if (< 0.05).
Results
Eleven
women ( 4 from group A & 7 from group B) did not attend for
follow-up. At 6 weeks follow-up, a highly significant lower rate of
post-surgical IUAs was found in group (A): only one out of 36 women
compared with group (B): 8 out of 25 patients {2.8 % versus 32 % ; P
< 0.05}. Evaluation of IUAs staging by AFS system, showed a
significant decrease in adhesions severity in the patient from group A (
stage I ) when compared with women from group B: 6 patients (stage II)
& 2 patients (stage III ){P < 0.05}. No complications or adverse
MEBO-related effects were detected in group A patients.
