Meta-analysis of the use of amniotic membrane to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

Background: Various adjuvant therapies have failed to improve clinical symptoms and pregnancy rates among patients with moderate-to-severe intrauterine adhesion. Objectives: To evaluate the ability of amniotic membrane to prevent the recurrence of intrauterine adhesion after hysteroscopic adhesiolysis. Search strategy: The Cochrane Library, Embase, and PubMed databases were searched for articles published before December 31, 2017, using the terms: ("amnion") and ("intrauterine adhesions" or "Asherman syndrome" or "IUA" or "endometrial injury" or "uterine adhesion" or "hysteroscopic" or "hysteroscopic adhesiolysis"). Selection criteria: Randomized controlled trials of amniotic membrane therapy after hysteroscopic adhesiolysis. Data collection and analysis: Four studies were included in the meta-analysis (300 patients in total). Dichotomous outcomes were expressed as relative risk (RR) with 95% confidence intervals (CIs). Continuous variables were expressed as mean difference. Main results: Amniotic membrane increased menstrual blood volume after hysteroscopic adhesiolysis (mean difference 6.15, 95% CI 4.20-8.11; P<0.001). By contrast, this treatment did not affect the rates of intrauterine adhesion recurrence (RR 0.84, 95% CI 0.61-1.16; P=0.290); pregnancy (RR 1.40, 95% CI 0.78-2.50; P=0.260); or spontaneous abortion (RR 0.88, 95% CI 0.38-1.99; P=0.750). Conclusions: The use of amniotic membrane increased menstrual blood volume but failed to improve other measures assessed in the current meta-analysis.