Epidemiology, clinical profile and limitations of hysteroscopic management at a public health facility in Yaoundé

Abstract

Introduction: Uterine synechiae are abnormal partial or total adhesions of the uterine wall, caused by endometrial trauma.

Methods: We conducted a retrospective cross-sectional study comprising data from 1st Uterine January 2017 to 31st May 2022 at CHRACERH. Variables consisted of demographic, clinical and paraclinical data. Data were analyzed using SPSS version 26.

Results: A total of 759 cases of hysteroscopy were examined, with uterine synechiae representing 20.9% (n=159). Among these, 62 files and videos were suitable for use. The mean age was 43.1±6.8 years. Most patients had a history of at least one abortion
(71%; n=44), and were nulliparous (72.6%; n=45). Risk factors identified included myomectomy via laparotomy (58.1%; n=36), and curettage and aspiration (45.2%). A case of genital tuberculosis was found (1.6%). Uterine synechiae were suspected and
confirmed based on symptoms presented in 48.8% of patients, while in 51.6% of patients, it was made following infertility work-up. Transvaginal ultrasound was performed in all patients with a sensitivity of 9.7% (6/62). Hysterosalpingography was performed in 32
women and showed a sensitivity of 59.4% (19/32).

Conclusion: Uterine synechiae were treated at an advanced aged. The most common risk factor was laparotomy indicated for myomectomy. Hysterosalpingography had a low sensitivity in diagnosing synechiae.