Prenatal 3D ultrasound and MRI assessment of horizontal uterine synechia

A Case Report of Asherman's Syndrome With Abnormal Placenta Implantation (Intrauterine Adhesion)

We report the case of a 28-year-old patient with a partial placental insertion on an intrauterine adhesion diagnosed at 20 weeks' gestation. The increasing incidence of intrauterine adhesions during the last decade has been attributed to the rising number of uterine surgeries in the fertile population and better imaging studies facilitating diagnosis. Although uterine adhesions during pregnancy are generally considered benign, the existing evidence is conflicting. The obstetric risks in these patients are unclear, but higher numbers of placental abruption, preterm premature rupture of membranes (PPROM), and cord prolapse have been reported. Thus, a prenatal diagnosis should prompt close feto-maternal observation. Surgical resection should be offered to patients with adhesions found prior to pregnancy.

HDlive imaging of vertical, bridging uterine synechia during pregnancy

We present a case of vertical, bridging uterine synechia in the central part of the uterine cavity diagnosed by conventional two-dimensional (2D) sonography and HDlive at 29 weeks and 5 days of gestation. 2D sonography showed a uterine synechia located vertically in the central part of the uterine cavity, dividing the lower uterine cavity into two parts. HDlive clearly revealed triangular, vertical, and bridging uterine synechia with foot protrusion and umbilical cord prolapse in the lower uterine cavity. The low, liquor-filled amniotic cavity was divided by a thin membrane. MRI confirmed the vertical structure dividing the uterus with umbilical cord prolapse. Emergency cesarean section was performed at 37 weeks and 1 day of gestation because of onset of labor, and a female infant weighing 2,380 g was delivered with an umbilical artery pH of 7.25, and Apgar score of 6/9 at 1 and 5 min, respectively. The vertical, bridging synechia in the central part of uterine cavity was confirmed during the operation.