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Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 853269, 6 pages
http://dx.doi.org/10.1155/2012/853269
Review Article

Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

1Centre for Reproduction, Department of Obstetrics and Gynaecology, Uppsala University Hospital, 751 85 Uppsala, Sweden
2Department of Obstetrics, Gynaecology and Breast Pathology, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain

Received 14 July 2011; Accepted 17 October 2011

Academic Editor: Horace Fletcher

Copyright © 2012 Pietro Gambadauro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.