”A condition characterised by formation of intrauterine adhesions”- Uterine Synechiae

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Uterine Synechiae

Asherman syndrome (AS), also known asuterine synechiae , is a condition characterised by formation of intrauterine adhesions. It results from injury to the endometrium, and is often associated with infertility. It has been reported and studied for more than a century. This disease occurs mainly as a result of the trauma of dilatation and curettage, postabortal infection, hypoestrogenism, genital tuberculosis, and previous uterine surgery, producing partial or complete obliteration in the uterine cavity and/or the cervical canal, resulting in conditions such as amenorrhea, hypomenorrhea, infertility, or recurrent pregnancy loss.

There is a tendency for the condition to develop soon after a pregnancy (usually within 4 months), the incidence is thought to be increasing probably as a result of increased use of intrauterine intervention.Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain.

Diagnosis

Hysterosalpingogram

Intrauterine adhesions are typically seen on HSG as multiple irregular linear filling defects (may give a lacunar pattern), with inability to appropriately distend the endometrial cavity . In severe cases there can even be complete non-filling of the uterine cavity.

Pelvic ultrasound

May be seen as hyperechoic bands traversing through the endometrial cavity.

Sonohysterography may be useful for evaluation.

Pelvic MRI

The adhesions are usually low signal on T2.

Treatment and prognosis

The goal of treatment is to remove adhesions and subsequently restore the normal size and shape of the uterine cavity. This is most commonly done by lysis of adhesions via hysteroscopy.

Symptoms

Symptoms may include secondary amenorrhea, pelvic pain, recurrent spontaneous abortions (SABs), and/or infertility in a female of childbearing age.

Severity of symptoms ranges from mild to moderate to severe, depending on the degree of adhesions (e.g., number, density, thickness, quality).

Risk Factors

90% of cases result from curettage such as:

Diagnostic curettage

Postabortion curettage

Postpartum curettage especially >48 hours postpartum

Other risk factors include the following:

• Cesarean section

• Pelvic radiation

• Polypectomy

• Intrauterine device (IUD) insertion

• Myomectomy

• Postpartum hemorrhage

• Recurrent SABs

• Pelvic infection (e.g., endometrial tuberculosis or pelvic inflammatory disease)—controversial

Prevention

Minimize intrauterine operative interventions while women are fertile and desire pregnancy.

Expectant or medical managemenlt rather than surgical management of SABs