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Zhao Y, Huang X, Huang R, Xu R, Xia E, Li TC. A retrospective cohort study to examine factors affecting live birth after hysteroscopic treatment of intrauterine adhesions. Fertil Steril 2024; 121:873-880. [PMID: 38246404 DOI: 10.1016/j.fertnstert.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate independent factors that affect the chance of live birth (LB) after hysteroscopic adhesiolysis in patients with intrauterine adhesions. DESIGN Retrospective cohort study. SETTING Hysteroscopic center of Fuxing Hospital in Beijing, China. PATIENT(S) Patients diagnosed with Asherman syndrome between June 2020, and February 2022. INTERVENTION(S) Hysteroscopic adhesiolysis is followed by a second look hysteroscopy to assess the outcome and follow-up for a year. MAIN OUTCOME MEASURE(S) Live birth rate (LBR) without the use of assisted reproductive technologies at 12-month follow-up. RESULT(S) Of the 544 women included in the cohort, the pregnancy rate at the end of 1 year of follow-up was 47.6% (95% confidence interval [CI] 45.5%-49.7%), and the LBR was 41.0% (95% CI 38.9%-43.1%). Stepwise multiple logistic regression analysis identified three independent predictors of LB in decreasing order of significance: increase in menstrual flow after surgery (odds ratio [OR] 3.69, 95% CI 1.77-8.21), postoperative endometrial thickness in the midluteal phase (OR 1.53, 95% CI 1.31-1.80), and the severity of recurred adhesion at second-look hysteroscopy (OR 0.62, 95% CI 0.50-0.76). Among subjects with good independent prognostic factors, namely, increased menstrual flow after surgery, postoperative endometrial thickness in the midluteal phase >6 mm, and no or minimal recurrence of adhesions at second-look hysteroscopy, the LBR was 69.0% (95% CI 65.4%-72.6%). On the other hand, in women (n = 26) without any of the three good prognostic factors, none had a successful LB (0). CONCLUSION(S) Overall, the LBR after treatment for Asherman syndrome was 41.0%. The prognosis is dependent on three outcome measures after surgery, namely, improvement in menstrual flow, postoperative endometrial thickness, and the minimal degree of recurrent adhesions at second-look hysteroscopy.
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Affiliation(s)
- Yuting Zhao
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaowu Huang
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rui Huang
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ruonan Xu
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Enlan Xia
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tin Chiu Li
- Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China; Union Hospital Reproductive Medicine Centre, Hong Kong, People's Republic of China.
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Siferih M, Gebre T, Hunduma F, Abebe A, Gebremichael A, Sewunet H, Shibabaw T. Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting. BMC Womens Health 2024; 24:99. [PMID: 38326846 PMCID: PMC10848492 DOI: 10.1186/s12905-024-02944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Asherman syndrome is one of the endometrial factors that influence a woman's reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. METHOD A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul's Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. RESULT A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21-39) at the initial presentation, and 32.3 years (range: 22-40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. CONCLUSION Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.
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Affiliation(s)
- Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Ethiopia.
| | - Thomas Gebre
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fufa Hunduma
- Field Epidemiology, Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Abebe
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Habtamu Sewunet
- Department of Midwifery, Debremarkos Comprehensive Specialized Hospital, Debremarkos, Ethiopia
| | - Tewodros Shibabaw
- School of Medicine, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
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Khan Z. Etiology, Risk Factors, and Management of Asherman Syndrome. Obstet Gynecol 2023; 142:543-554. [PMID: 37490750 DOI: 10.1097/aog.0000000000005309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
Asherman syndrome is characterized by a triad of symptoms including pain, menstrual abnormalities, and infertility and is a result of intrauterine scar tissue after instrumentation of a gravid uterus. Saline sonohysterogram is typically the most sensitive diagnostic tool; however, hysteroscopy is the criterion standard for diagnosis. Treatment includes hysteroscopic-guided lysis of adhesion, with restoration of the anatomy of the uterine cavity. Several modalities are used in an attempt to reduce the reformation of scar tissue after surgery; however, there is no consensus on the ideal method. Stem cells and platelet-rich plasma are being explored as means of regenerative therapy for the endometrium, but data remain limited. At present, most individuals can have restoration of menstrual function; however, lower pregnancy rates and obstetric complications are not uncommon. These complications are worse for patients with a higher grade of disease. Efforts are needed in standardizing classification, reducing uterine instrumentation of the gravid uterus, and referring patients to health care professionals with clinical expertise in this area.
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Affiliation(s)
- Zaraq Khan
- Division of Reproductive Endocrinology & Infertility and the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
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Esfandyari S, Elkafas H, Chugh RM, Park HS, Navarro A, Al-Hendy A. Exosomes as Biomarkers for Female Reproductive Diseases Diagnosis and Therapy. Int J Mol Sci 2021; 22:ijms22042165. [PMID: 33671587 PMCID: PMC7926632 DOI: 10.3390/ijms22042165] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Cell-cell communication is an essential mechanism for the maintenance and development of various organs, including the female reproductive system. Today, it is well-known that the function of the female reproductive system and successful pregnancy are related to appropriate follicular growth, oogenesis, implantation, embryo development, and proper fertilization, dependent on the main regulators of cellular crosstalk, exosomes. During exosome synthesis, selective packaging of different factors into these vesicles happens within the originating cells. Therefore, exosomes contain both genetic and proteomic data that could be applied as biomarkers or therapeutic targets in pregnancy-associated disorders or placental functions. In this context, the present review aims to compile information about the potential exosomes with key molecular cargos that are dysregulated in female reproductive diseases which lead to infertility, including polycystic ovary syndrome (PCOS), premature ovarian failure (POF), Asherman syndrome, endometriosis, endometrial cancer, cervical cancer, ovarian cancer, and preeclampsia, as well as signaling pathways related to the regulation of the reproductive system and pregnancy outcome during these pathological conditions. This review might help us realize the etiology of reproductive dysfunction and improve the early diagnosis and treatment of the related complications.
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Affiliation(s)
- Sahar Esfandyari
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.E.); (H.E.); (R.M.C.)
- Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Hoda Elkafas
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.E.); (H.E.); (R.M.C.)
- Department of Pharmacology and Toxicology, Egyptian Drug Authority (EDA) Formally, (NODCAR), Cairo 35521, Egypt
| | - Rishi Man Chugh
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.E.); (H.E.); (R.M.C.)
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Hang-soo Park
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (H.-s.P.); (A.N.)
| | - Antonia Navarro
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (H.-s.P.); (A.N.)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (H.-s.P.); (A.N.)
- Correspondence: ; Tel.: +1-773-832-0742
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Miklošová M, Mára M. Ashermans syndrome: the description of two case reports. Ceska Gynekol 2018; 83:440-444. [PMID: 30848149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To point out the importance of proper indication and careful performance of intrauterine surgical procedures. To highlight the key role of early diagnostic and treatment of intrauterine adhesions. SETTING Department of Obstetrics and Gynecology, Hospitals of Pardubice Region, Chrudim Hospital. Clinic of Obstetrics and Gynecology, General University Hospital in Prague and 1st Faculty of Medicine Charles university. DESIGN Case report. METHODS The description of 2 different cases of the patients with the Asherman´s syndrome. CONCLUSION Ashermans syndrome is a serious condition with complicated treatment and uncertain prognosis regarding fertility. Primary prevention as well as timely diagnosis and treatment seems to be crucial in the management of this patology. Keywords Ashermans syndrome, intrauterine adhesions, surgical revision of uterine cavity, hysteroscopy.
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Ramírez-Sánchez LR, Alanis-Fuentes J, Morales-Domínguez L. [Intrauterine synechiae after use of monopolar resectoscope]. Ginecol Obstet Mex 2015; 83:340-349. [PMID: 26285485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Uterine synechiae are defined as abnormal adhesions and fibrosis within the uterine cavity due to direct trauma or injury to the basal membrane of the endometrium. OBJECTIVE To identify, by routine hysteroscopy, how many patients who were treated because of intrauterine pathology developed uterine synechiae within the first six months after treatment with monopolar resectoscope. MATERIAL AND METHOD A descriptive, open, observational, retrospective and cross-sectional study was performed at Hysteroscopy Unit, Gynecology Service of General Hospital Manuel Gea Gonzalez, Mexico City. From January 1, 2008 to December 31, 2011, we took, from the record books of the operating rooms, the file number of those patients who were treated with monopolar resectoscopy, and subsequently underwent routine hysteroscopy within the first six months. RESULTS 69 records were included in the study. The main diagnoses were: endometrial polyp in 48% (n=33), submucosal myoma in 45% (n=3 1); 48% (n=33) polypectomy and 45% (n=31) myomectomy. Within the first six months after the main procedure, patients underwent a routine hysteroscopy, which revealed the development of intrauterine synechiae in 5.8% (n=4) of the patients. Of the patients who underwent myomectomy, 5.8% (n=4) developed uterine synechiae; while those patients who underwent polypectomy, synechiaes were not found. Minimal synechiaes were found in 4.3% (n=3) of patients, moderate synechiaes were found in 1.4% (n=1) of patients, and severe synechiaes were found in none patient. CONCLUSION Uterine synechiaes were found in 5.8% of patients with intrauterine pathology and treated with monopolar resectoscopy. Minimal to moderate synechia occur more commonly after myomectomy.
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Pulcinella R, Giannone L, Candelori E, Giannone E, Patacchiola F. Post-traumatic amenorrhea: the role of diagnostic and operative hysteroscopy in the prevention, diagnosis, differential diagnosis and treatment. Minerva Ginecol 2014; 66:69-76. [PMID: 24569405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of the study was to evaluate the clinical usefulness of the selective removal of residual intrauterine trophoblastic tissue by using a hysteroscopic procedure, especially in the prevention of the Intra-Uterine Adhesion's Syndrome. METHODS Seventy-six patients had an Asherman's Syndrome: 5 cases after laparotomic myomectomy, 1 after caesarean section, 2 after hysteroscopic myomectomy, 10 after VIP, 1 with a severe vaginal endometriosis, 1 after conisation, 4 after a post-partum hemorrhage due to coagulopathy or uterine atony, 20 cases after D&C because of PPH due to placental retention, 26 after repetitive D&Cs because of AUB due to post abortion chorial residues' retention, 6 cases after D&C for post menopausal AUB. Thirty-six patients presented AUB due to chorioplacental residues retention: 14 cases after a vaginal delivery or a caesarean section, 4 after VIP, 18 cases after repetitive D&Cs for incomplete or internal spontaneous abortion. Complete physical examination, transvaginal ultrasonography and operative hysteroscopy was offered as first treatment to all patients. Surgical treatment of IUA depends on the type (I-IV) and is based on the section of synechiae, liberation of the uterine cavity and tubal recesses, recovery of the residual endometrium to restore the physiology of the reproductive tract. Our technique to remove the chorioplacental residues is based on: correct use of loops and electric currents, enucleation by cold loops of the base of the placental implant, and to single out the level of miometrial infiltration. RESULTS After treatment we have noticed: two hysterectomies (for persistent AUB after myomectomy and for severe bleeding after dehiscence of a C. section), restoration of regular menstruations in 94.6% of patients (6 women in menopause), disappearance of pelvic pain and dysmenorrhea in all cases (100%), 8 pregnancies of the 9 women who were wanting child after hysteroscopic synechiolysis (88.9%). CONCLUSION According to the present study, the best way to prevent IUA is to make D&C for abortion, avoiding waiting longer than 24 hours, perform a D&C and then a diagnostic hysteroscopy after PPH in symptomatic women, reserve D&Cs only for a PPH, or an incomplete abortion, limit to only one D&C, always make a diagnostic hysteroscopy after D&C and uterine plugging for PPH.
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Affiliation(s)
- R Pulcinella
- Section of Gynecology and Obstetrics "San Donato" Hospital, Arezzo, Italy -
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Li C, Wei ML, Lin XN, Huang QX, Huang D, Zhang SY. [Effects of early intervention of second-look office hysteroscopy in the prevention of adhesion reformation for moderate-severe Asherman's syndrome]. Zhonghua Yi Xue Za Zhi 2013; 93:3617-3619. [PMID: 24534315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the efficacy of different time interval in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-severe Asherman's syndrome. METHODS A total of 125 women with moderate-severe Asherman's syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled into this retrospective cohort study. All patients underwent second-look hysteroscopy after a certain period of the first hysteroscopic adhesiolysis, and the operation would be performed again if any adhesion existed. According to the different time interval of hysteroscopy examination, they were divided into 3 groups: A: < 1 month (n = 50), B:1-2 months (n = 39), C >2 months (n = 36). The effect of hysteroscopic adhesiolysis was evaluated by American Fertility Society (AFS) score. RESULTS The AFS score decreased significantly after hysteroscopic adhesiolysis in each group and the normal uterine rate was up to 64.8%. The median of decreased AFS score and normal uterine rate were as follows:group A:7 point and 78%, group B:7 point and 66.7%, group C:5 point and 44.4%. And groups A and B achieved significantly (P < 0.01) greater reductions in the adhesion score than that of group C. The median time of recovery to normal uterine cavity were 1.64, 2.75 and 5.26 months in each group and great differences existed among them (P < 0.01). CONCLUSION The time interval of second-look hysteroscopy less than 1 month offers a better prognosis in the prevention of adhesion reformation for moderate-severe Asherman's syndrome.
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Affiliation(s)
- Chao Li
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Min-ling Wei
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xiao-na Lin
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Qiong-xiao Huang
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Dong Huang
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Song-ying Zhang
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
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Vancaillie TG, Garad R. Asherman's syndrome. Aust Nurs J 2013; 20:34-36. [PMID: 23600077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Daaloul W, Ouerdiane N, Masmoudi A, Ben Hamouda S, Bouguerra B, Sfar R. [Epidemiological profile, etiological diagnosis and prognosis of uterine synechias: report of 86 cases]. Tunis Med 2012; 90:306-310. [PMID: 22535345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Uterine synechias may pose real problems for fertility prognosis. It depends mainly on its etiology. AIM To study the epidemiological profile of patients, describe the circumstances of discovery of uterine synechias, specify the diagnostic procedures for pelvic ultrasound, hysterography and hysteroscopy and estimate the benefits on fertility. METHODS A retrospective study over a period of 10 years from 1 January 2000 to December 31, 2009 in the department of obstetrics gynecology B Charles Nicolle's Hospital in Tunis. RESULTS We collected 86 patients. The age average was 35.42 years, gestit average of 1.36 with 37.2% of nulligeste and an average parity of 0.67. The uterine revision was the main etiology (55.8%). The main circumstance of discovery was the exploration of infertility (60%). Hysterosalpingography showed a luminal filling defect in 79% of patients mostly fundic location (37.3%). Faced with data from the hysteroscopy sensitivity of HSG was 78% and positive predictive value was 100%. For the seat of the synechia its sensitivity is only 40%. The surgical procedure took place in one time in 74 cases. Our complication rate is 8.14%: 2 uterine perforations, 2 falseroads and 3 cases of hemorrhage stopping surgery. CONCLUSION The main etiology is a history of uterus revision. The main circumstance of discovery is the exploration of infertility. Anatomic results were generally good as testified hysteroscopy control.
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Affiliation(s)
- Walid Daaloul
- Service de gynecologie obstetrique, B. Hopital Charles Nicolle, Tunis
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Heinonen PK. [Intrauterine adhesions--Asherman's syndrome]. Duodecim 2010; 126:2486-2491. [PMID: 21171473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Intrauterine adhesions known as Asherman's syndrome evolve after trauma to the basal layer of the endometrium usually secondary to curettage of a recently pregnant uterus. The lesions range from minor to severe cohesive adhesions that affect menstrual function and fertility. Operative hysteroscopy is the mainstay of diagnosis, classification and treatment of the intrauterine adhesions. Significantly obliterated cavity may require multiple hysteroscopic adhesiolysis to achieve a satisfactory anatomical and functional result. Operative hysteroscopy for selective curettage of residual trophoblastic tissue instead of nonselective conventional curettage may prevent intrauterine adhesions.
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Affiliation(s)
- J Cheung
- Derby City General Hospital, Derby DE22 3NE
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Yasmin H, Nasir A, Noorani KJ. Hystroscopic management of Ashermans syndrome. J PAK MED ASSOC 2007; 57:553-555. [PMID: 18062521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To confirm the diagnosis of Asherman's syndrome in patients with scanty menses/amenorrhoea or infertility and to assess the effectiveness of hysteroscopy in the treatment of Asherman's syndrome. METHODS A hospital based descriptive study conducted on 20 patients presenting with amenorrhoea, oligomenorrhoea, or infertility from Jan 2004 to June 2005. They were selected after excluding hormonal imbalances, premature ovarian failure and congenital uterine abnormalities. All patients underwent diagnostic hysteroscopy and resection of adhesions. Specimens were sent for Histopathology and bacterial culture. RESULT A total of 20 patients were included in this study, the median age was 26 years, 65% had presented with scanty menses with secondary infertility, 20% with secondary ammenorrhoea, and 15% with primary infertility alone. Hysteroscopic findings showed thick fibrous adhesions in 45% patients, 40% had flimsy adhesions and 15% had muscular adhesions. It was seen that 65% had adhesions in the body of uterus, 25% at the site of internal os and 1% had adhesions in the cervical canal as well as the body of the uterus. Normal menstrual cycle was resumed in 95% patients, whereas two patients conceived and were followed to term. Dense fibrous tissue with few patches of calcification and no signs of secretory or proliferative cells was found in 35% patients. In 45% endometrium showed proliferative changes and collagen fibers. Only 1 patient had a positive AFB culture and the histopathology showed few graulomas with epitheloid cells most of the tissue replaced by necrotic tissue with patchy areas of caseation. CONCLUSION Hysteroscopy is an effective procedure for not only diagnosing Ashermans Syndrome, but is equally effective for treating it..
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Affiliation(s)
- Haleema Yasmin
- Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi
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Affiliation(s)
- Nadia Kabli
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
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Abstract
PURPOSE OF REVIEW To review the etiology, diagnosis, and clinical manifestations of intra-uterine adhesions and to address treatment with a specific focus on fertility outcome. RECENT FINDINGS Intra-uterine adhesions can cause recurrent pregnancy loss and infertility. The gravid or recently postpartum uterus is particularly susceptible to adhesion formation following instrumentation. While sonohysterography and hysterosalpingography are useful as screening tests of intra-uterine adhesions, hysteroscopy remains the mainstay of diagnosis and treatment. Hysteroscopic lysis of adhesions with scissors, electrosurgery, or laser can restore the size and shape of the endometrial cavity. Significantly obliterated cavities may require multiple procedures to achieve a satisfactory anatomical result. Postoperative mechanical distention of the endometrial cavity and hormonal treatment to facilitate endometrial regrowth appear to decrease the high rate of adhesion reformation. Newer antiadhesive barriers may also prevent the recurrence of intra-uterine adhesions. Endometrial development can remain stunted due to a scant amount of residual functioning endometrium and fibrosis. Potential pregnancy complications, especially placenta accreta, after the treatment of intra-uterine adhesions should be anticipated and discussed with the patient. SUMMARY Diagnosis and treatment of intra-uterine adhesions are integral to the optimization of fertility outcomes. Favorable results in terms of pregnancy and live birth rates can be expected after hysteroscopic adhesiolysis.
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Affiliation(s)
- Pinar H Kodaman
- Yale University School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Reproductive Endocrinology and Infertility, New Haven, Connecticut 06520, USA.
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Efetie ER. Reproductive outcome following treatment of intrauterine adhesions in Abuja, Nigeria. Niger J Clin Pract 2006; 9:164-8. [PMID: 17319351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CONTEXT Infertility and menstrual abnormalities continue to constitute a significant bulk of gynaecological consultations. Both of these problems are sometimes traced to intrauterine adhesions (IUA) which is preventable in the majority of cases. Endoscopic lysis under direct vision is being introduced into contemporary practice in Nigeria for the treatment of this condition, and is about to commence in this centre. OBJECTIVE To evaluate the reproductive outcome following treatment of intrauterine adhesions with the mainly traditional division of adhesions, Lippes loop insertion and exogenous hormone supplementation. STUDY DESIGN, SETTING AND SUBJECTS A retrospective analysis of IUA at the National Hospital Abuja, Nigeria from the period: from 1st September 1999 to 31st August 2004 was carried out in September 2005 for evaluation of their treatment. One patient was lost to follow up and a total of 71 case records were analyzed. MAIN OUTCOME MEASURES Reproductive outcome among participants with regard to resumption of normal menstruation and becoming pregnant. RESULTS The incidence of IUA was 1.73% of new patients. Mean age +/- SD was 29.97 +/- 4.82 years. Patients who were Para 0 to 1 constituted 81.9% of the total. Resumption of normal menstruation occurred in 34 (47.9%) patients. At the time of assessment, 17 women (23.9%) were still amenorrhoeic, 15 women (21.1%) were hypomenorrhoeic while 5 women (7.0%) still had oligomenorrhoea. Eight women (11.3%) had achieved a pregnancy within the study period. CONCLUSION The reproductive outcome following treatment of intrauterine adhesions in this centre is not encouraging and needs improvement. Adoption of more successful treatment modalities like hysteroscopic adhesiolysis is advocated.
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Affiliation(s)
- E R Efetie
- Department of Obstetrics and Gynaecology National Hospital Abuja, Nigeria.
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Nishi Y, Takeshita T. [Asherman syndrome]. Nihon Rinsho 2006; Suppl 2:418-21. [PMID: 16817433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Yayoi Nishi
- Department of Obstetrics and Gynecology, Nippon Medical School
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Dalton VK, Saunders NA, Harris LH, Williams JA, Lebovic DI. Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure. Fertil Steril 2006; 85:1823.e1-3. [PMID: 16674955 DOI: 10.1016/j.fertnstert.2005.11.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 11/01/2005] [Accepted: 11/01/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the occurrence of intrauterine adhesions after manual vacuum aspiration for early pregnancy failure. DESIGN Case series. SETTING Tertiary care center. PATIENT(S) Three women with intrauterine adhesions after manual vacuum aspiration for the treatment of early pregnancy failure. INTERVENTION(S) Chart review. MAIN OUTCOME MEASURE(S) Hysteroscopic diagnosis of intrauterine adhesions after manual vacuum aspiration. RESULT(S) Three cases of symptomatic intrauterine adhesions after manual vacuum aspiration. CONCLUSION(S) Intrauterine adhesion formation may follow manual vacuum aspiration for early pregnancy loss.
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Affiliation(s)
- Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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Uchil D, Uddin R, Omar K, Hill NCW. Unusual cause of secondary amenorrhoea. J OBSTET GYNAECOL 2006; 26:272-3. [PMID: 16698645 DOI: 10.1080/01443610600559750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D Uchil
- Department of Obstetrics and Gynaecology, The Princess Royal University Hospital, Farnborough, UK
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Abstract
Although Asherman's syndrome (the presence of adhesions inside the cervical canal or uterine cavity) is relatively uncommon in the general population, it can be the cause of menstrual irregularity and subfertility in high risk women. The diagnosis is usually confirmed by hysterosalpinography, and more recently by hysteroscopy. Hysteroscopy has also become accepted as the optimum route of surgery, the aims being to restore the size and shape of the uterine cavity, normal endometrial function and fertility. Treatment can range from simple cervical dilatation in the case of cervical stenosis but an intact uterine cavity, to extensive adhesiolysis of dense intrauterine adhesions using scissors or electro- or laser energy. Patients in whom the uterine fundus is completely obscured, and those with a greatly narrowed, fibrotic cavity present the greatest therapeutic challenge. Several techniques have described for these difficult cases, but outcome is far worse than in patients with mild, endometrial-type adhesions. Non-hysteroscopic techniques area also beginning to be developed, but whether they will replace the current 'gold' standard of hysteroscopy remains to be seen.
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Affiliation(s)
- Adam Magos
- Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
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Olaore JA, Shittu OB, Adewole IF. Intravesical Lippes loop following insertion for the treatment of Asherman's syndrome: a case report. Afr J Med Med Sci 1999; 28:207-8. [PMID: 11205834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A case report of a 36-year-old Para 6+0 (1 alive) civil servant who developed Asherman's syndrome following repair of ruptured uterus is presented. She had adhesiolysis and insertion of Lippes loop. She defaulted 3 months after presentation and was seen 1 year after with intravesical translocation of the IUCD. This was successfully removed using a forward biting bladder biopsy forceps under direct cystoscopic view.
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Affiliation(s)
- J A Olaore
- Departments of Obstetrics and Gynaecology, College of Medicine, University College Hospital, Ibadan, Nigeria
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