The SYNAPPH Study: Uterine synechiae prevalence after a post-partum hemorrhage, a pilot study.

To prospectively assess the prevalence of intrauterine synechia following medically-treated post-partum hemorrhage (PPH) and to evaluate the association between synechiae formation and PPH management techniques. A prospective observational cohort study SETTING: Angers University Hospital PARTICIPANTS: A total of 83 women presenting with medically-treated PPH from January to December 2021 were included in the study. Diagnostic hysteroscopy was performed twelve weeks postpartum to assess for the presence of uterine synechiae. Detailed data on PPH management techniques were collected for analysis. The majority of participants were primiparous and had undergone vaginal delivery. Only 7% required intrauterine balloon tamponade (IUBT), and 4% underwent uterine artery embolization. Uterine synechiae were identified in 20 women during diagnostic hysteroscopy, yielding a prevalence of 24% at 12 weeks postpartum; all classified as type I according to the ESGE classification system. IUBT was used in 15% of women with synechiae compared to 5% in the non-synechiae group, although this difference was not statistically significant (OR 3.52, 95% CI 0.65-19.10, p=0.123). Multivariate analysis identified second manual uterine examination (OR 5.00, 95% CI 1.50-16.66, p=0.009) and bimanual uterine massage (OR 3.50, 95% CI 1.12-10.09, p=0.020) as independent risk factors for synechiae formation. This is the first study to evaluate the risk of intrauterine synechiae following medically treated PPH. Mild uterine synechiae were observed in one in four women in the cohort. The need for a second manual uterine examination and bimanual uterine massage were significantly associated with the development of synechiae. Further research is warranted to explore the long-term clinical consequences, including fertility outcomes, and to determine the potential role of diagnostic hysteroscopy in postpartum follow-up after PPH SUMMATION: The study prospectively investigates the prevalence of uterine synechiae following non-surgical postpartum hemorrhage, revealing a 24% occurrence, with second manual uterine examination and bimanual massage identified as independent risk factors.

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Declaration of competing interest The authors declare no conflict of interest.