The effect of the combined use of an intrauterine device and a Foley balloon in the prevention of adhesion following hysteroscopic adhesiolysis

Figures & data

Table 1. The clinical characteristics of each group.

	IUD group (n=31)	Foley balloon group (n=30)	Combined group (n=28)	P values
Age (mean ± SD), years	34.57 ± 4.43	33.60 ± 4.66	34.79 ± 3.52	.522*
Body Mass Index (mean ± SD)	22.8 ± 3.6	23.2 ± 4.2	22.7 ± 3.8	.872*
Degree of adhesion [n (%)]				.870^#
Moderate adhesion	20 (64.52)	21 (70.00)	18 (64.29)
Severe adhesion	11 (35.48)	9 (30.00)	10 (35.71)
Preoperative AFS score [median (range)]	8 (5–12)	7 (5–12)	7.5 (5–12)	.857&
Preoperative menstrual score (mean ± SD)	3.39 ± 1.91	3.57 ± 1.87	4.04 ± 2.12	.432*
Preoperative endometrial thickness (mean ± SD), cm	0.50 ± 0.06	0.51 ± 0.05	0.52 ± 0.05	.365*
Previous intrauterine operation [n (%)]				.819^#
D&C for induced abortion	7 (22.58)	8 (26.67)	6 (21.43)
D&C for delayed or incomplete miscarriage	19 (61.29)	14 (46.67)	15 (53.57)
D&C after induction delivery or postpartum	5 (16.13)	6 (20.00)	5 (17.86)
No operation	0 (0)	2 (6.67)	2 (7.14)

AFS: American Fertility Society; D&C: dilation and curettage. *The data were compared by one-way ANOVA; ^#The data were compared by Chi squared test or Fisher’s test; &The data were compared by Kruskal-Wallis rank test.

Table 2. Comparisons of AFS and menstrual scores in patients with intrauterine adhesions.

	IUD group (n=31)	Foley balloon group (n=30)	Combined group (n=28)	P values
AFS scores [median (range)]
Preoperative AFS score	8 (5–12)	7 (5–12)	7.5 (5–12)	.857
Postoperative AFS score	4 (0–10)	4.5 (0–9)	2.5 (0–9)	.182
Difference
Total [89]	4 (1–8) [31]	4 (1–7) [30]	4 (1–10) [28]*^#	.034
Moderate adhesion [59]	4 (2–8) [20]	4 (1–7) [21]	4 (1–9) [18]	.334
Severe adhesion [30]	3 (1–6) [11]	4 (1–6) [9]	5 (2–9) [10]*^#	.044
Menstrual scores (mean ± SD)
Preoperative menstrual score	3.39 ± 1.91	3.57 ± 1.87	4.04 ± 2.12	.432
Postoperative menstrual score	6.52 ± 1.34	6.63 ± 1.47	7.00 ± 1.33	.385
Difference
Total [89]	3.13 ± 1.54 [31]	3.07 ± 1.39 [30]	2.96 ± 1.29 [28]	.180
Moderate adhesion [59]	3.05 ± 1.61 [20]	3.14 ± 1.59 [21]	3.06 ± 1.55 [18]	.978
Severe adhesion [30]	3.27 ± 1.49 [11]	2.89 ± 0.78 [9]	2.80 ± 0.63 [10]	.564

AFS, American Fertility Society; IUD, intrauterine device. AFS scores were compared by Kruskal-Wallis rank test followed by pairwise comparisons of groups; Menstrual scores were compared by one-way ANOVA. Numbers in brackets are number of patients in each grade of adhesion in each group. *p < .05 vs. IUD group, ^#p <.05 vs. Foley balloon group.

Table 3. Comparisons of endometrial thickness in patients with intrauterine adhesions (mean ± SD).

	IUD group (n=31)	Foley balloon group (n=30)	Combined group (n=28)	P values
Preoperative endometrial thickness	0.50 ± 0.06	0.51 ± 0.05	0.52 ± 0.05	.365
Postoperative endometrial thickness	0.77 ± 0.09	0.77 ± 0.08	0.89 ± 0.09*^#	<.001
Difference	0.27 ± 0.07	0.26 ± 0.08	0.37 ± 0.11*^#	<.001

IUD, intrauterine device. The endometrial thickness was compared by one-way ANOVA followed by a LSD post hoc test. *p < .05 vs. IUD group, ^#p <.05 vs. Foley balloon group.