Operative hysteroscopy for intrauterine adhesions: Comparison between single and multiple procedures. A retrospective cohort

Objective To compare outcomes of operative hysteroscopy for intrauterine adhesions between single and multiple procedures. Methods This was a retrospective cohort in a teaching hospital including women of childbearing age treated by operative hysteroscopy for intrauterine adhesions between January 2010 and May 2020. One or more operative hysteroscopies were performed to remove intrauterine adhesions. The main outcome was occurrence of intrauterine pregnancy and live birth rate after operative hysteroscopy. Results A total of 454 women were included with 256 in the “single procedure” group and 198 in the “multiple procedures” group. Among these 454 women, 125 (27.5%) were lost to follow‐up. The intrauterine pregnancy rate was 44.1%, significantly lower in the “multiple procedures” group (36.7% vs. 50.0% [ P = 0.02]). The mean time before pregnancy was not significantly different between groups. For women who conceived, the live birth rate was 61%, not significantly different between groups. The risk of abnormal placentation was significantly higher in the multiple procedures group (37.5% vs. 13.8% [ P < 0.01]) such as the risk of postpartum hemorrhage (45.4% vs. 19.6% [ P = 0.01]). Conclusion Repeated procedures appear to increase risks of abnormal placentation and postpartum hemorrhage but it allows some women with severe adhesions to obtain a normal uterine cavity and to become pregnant.