Adhesions Asherman Syndrome

When the uterine cavity develops adhesions or fibrosis, resulting in obliteration of the cavity, the condition is called asherman syndrome. Usually develops after uterine surgery and is seen in approximately in 40% of patients who have undergone D&C for retained products of conception following childbirth or incomplete abortion. Severe pelvic infection may also lead to Asherman syndrome especially those affected with tuberculosis. Infection or D&C causes trauma to the endometrial lining. Healing of the endometrial lining is affected causing the damaged areas to fuse together.

Once these adhesions develop in the uterine cavity, women present with reduced bleeding during periods or lack of periods (ammenorrhoea). Asherman syndrome can also cause infertility or repeated miscarriages. The adhesions can be thin or thick, partial or complete. They are usually not vascular.

Treatment of Asherman syndrome is hysteroscopicadhesiolysis. Asherman's Syndrome must be treated by a very experienced surgeon. This is usually done by visualising the uterine cavity with the help of a thin telescope inserted into the uterus through the cervix. A camera is attached to the telescope and seen on a monitor like television. Small instruments are inserted into the uterus and surgery performed using hysteroscopic scissors. Treatment involves cutting and removing the adhesions or scar tissue. It is recommend to avoid energy sources inside the uterus as the energy devices can cause more damage and recurrence of adhesions.

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