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. 2019 Aug:59:98-114.
doi: 10.1016/j.bpobgyn.2018.12.009. Epub 2019 Jan 3.

Reproductive outcomes after surgical treatment of asherman syndrome: A systematic review

Emma Jun Guo  1 , Jacqueline Pui Wah Chung  2 , Liona Chiu Yee Poon  3 , Tin Chiu Li  4
Affiliations

Reproductive outcomes after surgical treatment of asherman syndrome: A systematic review

Emma Jun Guo et al. Best Pract Res Clin Obstet Gynaecol. 2019 Aug.

Abstract

In this systematic review, we analysed the reproductive outcomes of hysteroscopic adhesiolysis in women with Asherman syndrome (AS). We searched PubMed, Web of Science and Cochrane Library (from database inception to April 2018) and selected studies that quantitatively described the reproductive outcomes. We assessed study quality and pooled rate data for each outcome. There were 54 studies (4640 women) of varying quality. The pooled rate of pregnancy was 50.7% (95% CI [confidence interval]: 49.1 to 52.3) in 53 studies, early pregnancy loss was 17.7% (95% CI: 15.9 to 19.6) in 31 studies, ectopic pregnancy (EP) was 4.2% (95% CI: 2.8 to 6.3) in 9 studies, mid-trimester loss (MTL) was 11.5% (95% CI: 7.6 to 17.8) in 7 studies, cervical incompetence was 12.5% (95% CI: 3.3 to 33.5) in 2 studies and placenta accreta syndrome was 10.1% (95% CI: 8.6 to 11.8) in 23 studies. The pregnancy rate in women with severe adhesion was significantly lower than that in women with mild adhesion (P = 0.021). These results can be used to counsel women with AS before surgical treatment and for planning antenatal care after conception.

Keywords: Asherman syndrome; Intrauterine adhesion; Obstetric outcome; Reproductive outcome; Systematic review.

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