Asherman's syndrome

Asherman's syndrome, also called "uterine synechiae", presents a condition characterized by the presence of scars within the uterine cavity.

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Features

The cavity of the uterus is lined by the endometrium. This lining can be traumatized, typically after a dilation and curettage (D&C) done after a miscarriage, abortion, or delivery, and then develops intrauterine scars which can obliterate the cavity to a varying degree. In the extreme, the whole cavity has been scarred and occluded. Even with relatively few scars, the endometrium may fail to respond to estrogens and rests. The patient experiences secondary amenorrhea and becomes infertile.

An artificial form of Asherman's syndrome can be surgically induced by uterine ablation in women with uterine bleeding problems, in lieu of hysterectomy.

Diagnosis

The history of a pregnancy event followed by a D&C leading to secondary amenorrhea is typical. Imaging by gynecologic ultrasonography or hysterosalpingography will reveal the extent of the scar formation. Hormone studies show normal levels consistent with reproductive function. There are ways to lower the risk of developing Asherman's after a D&C, such as hormone therapy to cause sloughing off of the uterine lining.

Ultrasound is not a reliable method of diagnosing Asherman's Syndrome. Options include HSG (hysterosalpingography) or SHG (sonohysterography). Hysteroscopy is the most reliable.[1]

Treatment

Operative hysteroscopy is used for visual inspection of the uterine cavity and dissection of scar tissue.

Prognosis

The extent of scar formation is critical. Small scars can usually be treated with success. Extensive obliteration of the uterine cavity may require several surgical interventions or even be uncorrectable. Patients who carry a pregnancy after correction of Asherman's syndrome may have an increased risk of having a placenta that invades the uterus more deeply, leading to complications in placental separation after delivery.

History

It is also known as Fritsch syndrome, or Fritsch-Asherman syndrome per the individuals who described it, Heinrich Fritsch and Joseph G. Asherman.^[1][2]

References