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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Article info
Publication history
Accepted:
January 13,
2023
Received in revised form:
January 9,
2023
Received:
August 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.
