Clinical Observation Of The Combination Of Foley Catheter And Different Dosages Of Estrogen For Ancillary Treatment Of Intrauterine Adhesions

Background: Hysteroscopy is the gold standard for diagnosis of intrauterineadhesions(IUA). Transcervical resection of adhesions(TCRA) is now the firstchoice for the treatment of IUA. In order to prevent the reformation of adhesionsafter surgery, various methods have been used. It is reported that the combinationof Foley catheter and different dosages of estrogen can be used to achieve this aim.But there is no high-quality RCTs that focus on this.Objective: To evaluate the effects of the usage of Foley catheter with orwithout estrogen on ancillary treatment of IUAafter hysteroscopic adhesiolysis.To evaluate the effects of the combination of Foley catheter and estrogenwhich was given in the dosage of4mg/d and12mg/d on ancillary treatment ofIUAafter hysteroscopic adhesiolysis.Materials and Methods: We collect the clinical data of45patients whowere diagnosed IUA by hysteroscopy in Navy general hospital from January2012to December2013. And all of the patients underwent the TCRA successfully. Thepatients were divided into three groups according to different treatments afterTCRA: Group A was put an intrauterine Foley catheter after TCRA, and3~5mlsaline was injected in the catheter. The catheter was kept in place for5daysbefore pulled out. Group B was treated similar to Group A which involved theadministration of estradiol valerate(E2)4mg/d×21days after operation, anddydrogesterone20mg/d in the last ten days was added. Group C was treatedsimilar to Group B while the dosage of E2was12mg/d.One and three months after the surgery, all cases were followed up to identifythe recovery of the menstruation, adverse drug reaction, the liver function and renal function. Endometrial thickness was measured post-menstrual on day21ofGroup A and on day21of Group B and C after artificial menstrual cycle. Asecond look of hysteroscopy was performed three months after the surgery todetermine whether the cavity was normal. A long-term follow-up was performedto identify the pregnancy and live birth rates, the pregnancy complication, and themode of delivery.Results: None of the45patients were lost to follow up. And there were nosymptoms of the adverse drug reaction in all the patients. The hepatic and renalfunction were normal one month after surgery.1. The general states among the three groups: There were no significantdifference among the three groups including the patients’ mean age(P=0.837) andthe degree of IUA(P>0.05).2. The thickness of endometrium among the three groups: The pre-operativeand postoperative thickness of endometrium of each group was of no statisticalsignificance (Group A: P=0.893, Group B: P=0.506, Group C: P=0.070). Both thepre-operative(P=0.306) and postoperative(P=0.531) thickness of endometriumwere of no statistical significance among the three groups.3. The treatment outcome among the three groups: The treatment outcomewas of no statistical significance among the three groups(Group A=66.7%, GroupB=60%, Group C=66.7%; P>0.05).4. The pregnancy rate among the three groups: The pregnancy rate was of nostatistical significance among the three groups(Group A=46.7%, Group B=20%,Group C=46.7%; P>0.05).Conclusions: The postoperative administration of estrogen is not necessaryfor patients who are placed a Foley catheter balloon into uterine cavity at the endof TCRA. If postoperative estrogen is administered, we would rather take4mg/dthan take12mg/d.