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Levonorgestrel-releasing intrauterine system: a promising choice after uterovaginal anastomosis in patients with cervical dysgenesis

Published:January 21, 2023DOI:https://doi.org/10.1016/j.jpag.2023.01.002

      Abstract

      Background

      Cervical dysgenesis is categorized into cervical fragmentation, cervical fibrous cord, and cervical obstruction. The definitive management for cervical dysgenesis is either uterovaginal anastomosis (UVA) or hysterectomy.

      Objective

      To compare the prevalence of dysmenorrhea, hematometra, and need for dilatation following UVA with and without post-procedural placement of a levonorgestrel intrauterine system (LNG-IUS).

      Methods

      This is a retrospective cohort study in which 14 patients with cervical dysgenesis are included. Patients had undergone UVA between May 2015 and January 2022, at the Department of Obstetrics and Gynecology of the Cairo University Teaching Hospital. Six patients who had an LNG-IUS inserted after UVA were included in group A, while 8 patients who had undergone UVA without LNG-IUS insertion were included in group B. Transabdominal and/or transvaginal ultrasound were performed monthly for the first three months after LNG-IUS insertion in group A and after UVA in group B. Thereafter, the patients were followed up every 6 months. The primary outcomes were dysmenorrhea, hematometra, and need for dilatation of the anastomosis site.

      Results

      The number of patients who developed hematometra was significantly lower in group A than in group B (0 [0%] vs. 6 [75%], P=0.01). The number of patients who required dilatation was significantly lower in group A than in group B (0 [0%] vs. 6 [75%], P=0.01). There was no significant difference in the incidence of dysmenorrhea between the two groups.

      Conclusion

      We recommend offering LNG-IUS after UVA for adolescents who present with cervical dysgenesis. LNG-IUS decreases the recurrence of hematometra and subsequent surgical interventions.

      Keywords

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