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Abstract
The presence of intra-uterine synechiae has detrimental effects on normal menstruation and reproduction.
The most commen causes of intrauterine synechiae are:
1.Trauma to a gravid uterine cavity, induced mainly by uterine curettage in the postpartum period.
2. Trauma to nongravid uterus.
3. Infection.
4. Congenital anomalies of the uterus.
5. Genetic predisposition. While sonohysterography and hysterosalpingography represent useful screening tests for IUA, hysteroscopy is required for the definitive diagnosis and treatment of Asherman’s syndrome.
The main symptoms of intrauterine synechiae:
1. Menastrual abnormalities, including hypoamenorrhea and amenorrhea.
2. Infertility.
3. Repeated pregnancy loss and other pregnancy complications.
4. Difficulty in detection of endometrial malignancy.
A history of curettage of a gravid or recently postpartum uterus should heighten the suspicion for IUA, as this is the typical clinical scenario.
Hysteroscopic resection with the use of scissors, electrosurgery or laser should be implemented to restore normal anatomy. This may require multiple procedures, and adjuvant measures, such as laparoscopy, ultrasound, or fluoroscopy, can be used to guide the hysteroscopic procedure in the more severely affected patients.
Postoperative care should be tailored to the individual patient, and when moderate to severe adhesions are lysed the postoperative use of hormonal therapy to help prime the denuded endometrium and an intra-uterine Foley or balloon to mechanically separate the walls of the endometrial cavity may be beneficial in preventing the high rate of adhesion reformation.
Given the frequency of adhesion recurrence, second-look hysteroscopy or evaluation by other means, such as sonohysterography, is recommended.
Amenorrhea and hypomenorrhea usually resolve following the treatment of Asherman’s syndrome. Posttreatment pregnancy and live birth rates depend on the severity of the adhesions and are also influenced by the patient’s age and other infertility factors, if present.