- April 29, 2016
- Posted by: emobile
- Category: Trending Topic
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Emobileclinic Trending Topic
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:
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Cesarean section
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Pelvic radiation
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Polypectomy
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Intrauterine device (IUD) insertion
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Myomectomy
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Postpartum hemorrhage
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Recurrent SABs
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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