Asherman Syndrome

INTRODUCTION:
  • Asherman syndrome is the presence of intrauterine adhesions.
PATHOPHYSIOLOGY :
  • It is the result of scanty or poorly vascularised and dysfunctional endometrium resulting from trauma. Any result severe enough to remove or destroy endometrium can cause
  • adhesions.
ETIOLOGY :
  • Asherman syndrome : "Generally is the result of an overzealous postpartum curettage resulting in intrauterine scarification.
  • Dilatation and Curettage (D and C) done
  • After previous elective pregnancy termination.
  • For missed abortion
  • For hydatiform mole
  • After cesarean section
  • As a post operative complication of :

  1. Abdominal / hysteroscopic myomectomy
  2. Metroplasty
  3. Septoplasty
  4. Uterine artery embolisation for the traetment of uterine fibroids
  5. Chronic infection-like genital tuberculosis° and Schistosomiasis° or infection due to IUCD's.
SYMPTOMS:
  • Menstrual disorders like (hypomenorrhea, amenorrhea, dysmenorrhea). Amenorrhoea is the typical symptom.
  • Infertility (it results due to absence of viable endometrium for implantation as well as from obstruction of fallopian tubes).
  • Recurrent miscarriage (due to insufficient normal endometrial surface)
  • If patients of ashermann syndrome conceives, pregnancy is complicated by preterm labour, placenta accreta, placenta previa and / or PPH.
DIAGNOSIS:
  • Hysterosalpingography : (X – ray dye test) and saline hysterosalpingogram (fluid ultrasound) demonstrate filling defect. But either of the method is useful as a screening test. Hysteroscopy is both is the method of choice for diagnosis and treatment.
TREATMENT:
  • Hysteroscopic lysis of adhesions is the preferred surgical treatment.
  • Following surgery some method is used to keep the walls of the uterus apart in the immediate postoperative period to minimize the chances of recurrence. This is can be done by the use of Balloon Catheter or non Medicated IUCD's
  • Antibiotics are administered prior to the procedure and continued for approximately 10 days after the surgery.
  • Postoperative treatment with exogenous estrogens is given to promote rapid reepithelialization and reduce the risk of recurrent adhesion
Exam Question of:
  • The risk of Asherman syndrome is the highest if Dilatation and Curettage (D & C) is done for the Post partum haemorrhage condition.
  • Asherman syndrome is due to Postabortion curettage
  • The presentation of Asherman syndrome typically involves Hypomenorrhea
  • A 28 year old patient complains of amenorrhea after having dilatation & curettage.The most likely diagnosis is Asherman's Syndrome
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