Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions.

During diagnostic hysteroscopy, I found intrauterine adhesions in 192 patients; central adhesions appeared as a bridgelike tissue connecting the anterior and posterior walls of the uterus, and marginal adhesions appeared as a partial ledgelike tissue projected from a part of the uterine side wall. All of the central adhesions and most of the marginal adhesions were removed by pushing with the tip of the outer sleeve of the hysteroscope under visual control. Moreover, hysteroscopy made rough estimates of the histology of the adhesions from the surface appearance of the adhesions before removal, the force needed for separation, and the appearance of the stumps of adhesions removed. The effects of adhesionolysis were evaluated by recovery of endometrial function, that is, increase of menstrual blood flow and achievement of a viable pregnancy. Among the 192 patients, 143 recovered previous menstrual flow, the others remained hypomenorrheic. In 79 pregnant patients, 45 were delivered of viable infants. Improvement of endometrial malfunction in advanced cases of intrauterine adhesions is a problem awaiting a solution.