Determinants of uterine synechiae at hysteroscopy: a case-control study in Kinshasa, Democratic Republic of Congo

Abstract

In most cases, synechiae originate from traumatic uterine procedures in a gravid or non-gravid uterus. The aim of this study was to identify determinants of uterine synechiae in a population of Kinshasa. A case-control study was conducted at the Endo-conception Clinic in Kinshasa, DRC, from March 1^st, 2018, to February 28^th, 2023. Cases were patients with uterine synechiae in hysteroscopy, and controls were patients with normal hysteroscopy. The comparison of proportions was made using the Pearson Chi-square test and Fisher's Exact. The student's t-test was used to compare means whose variables were normally distributed and the comparison of the medians of parity and gravidity was made with the U Mann-Whitney test. The test was significant for a p-value < 0.05. A total of 223 patients with synechiae (cases) and 472 patients with normal hysteroscopy (controls) were collected. The mean age was 38.41 years ± 6.60 for cases and 36.91 years ± 6.86 for controls. Comparing cases to controls, history of curettage was present in 69.1% versus 37.3 %, history of uterine surgery in 58.7% versus 35.6% and dysmenorrhea in 17.9% versus 8.9%. Factors associated with uterine synechiae were dysmenorrhea (aOR: 2.51, 95% CI 1.54 - 4.19; p=0.000), history of curettage (aOR: 3.32, 95% CI 1.97 - 5.60; p = 0.000) and uterine surgery (aOR: 2.96, 95% CI 2.08 - 4.21; p = 0.000). The findings demonstrate a notable frequency of uterine synechiae in patients with a history of curettage, uterine surgeries, and dysmenorrhea in cases compared to controls, identifying them as determinants of the condition.