Asherman syndrome

Cervical or intrauterine adhesion (IUA) after abortion is also known as Asherman's syndrome, which was first reported by Asherman in 1948. It is caused by damage to the cervical mucosa or the dermis and muscle layer of the uterine wall during curettage, resulting in adhesion. It can be easily caused by multiple abortions, postoperative infection and low ovarian height after surgery. Patients with clinical symptoms of amenorrhea, oligomenorrhea and infertility.

A common cause of uterine amenorrhea, drug withdrawal test is negative, and then repeated growth hormone sequential tests, if there is no bleeding, indicating that the uterine wall is defective or damaged, can confirm uterine amenorrhea.

The common cause of intrauterine adhesions is actual intrauterine operations, such as artificial abortion and curettage. It can also be seen in uterine fibroid surgery, cesarean section, etc. In addition, infection, genital tuberculosis, obesity and age are also common high-risk factors. In China, abortion is the most important cause of intrauterine adhesions, with more than 13 million abortions performed each year. Data show that with the increase in the frequency of abortion operations, intrauterine adhesions increase exponentially.

Patients with intrauterine adhesions specifically present with decreased menstrual volume, increased bleeding time, and infertility. 88% of patients mainly present with idiopathic decrease in menstrual volume or amenorrhea after artificial abortion, with or without regular lower abdominal pain (this type of abdominal pain is often related to the menstrual cycle). Pregnancy and success rates have been reported to be related to the severity of adhesions. The pregnancy rates of patients with mild, mild-moderate, and moderate-to-severe intrauterine adhesions after treatment were 93%, 78%, and 57%, respectively. Of course, age is also a key factor affecting the pregnancy rate of patients with intrauterine adhesions after surgery. Even if patients with intrauterine adhesions are successful in becoming pregnant, they may still suffer from placenta accreta, premature birth, and cervical malformation. The success rates of treatment for patients with mild, mild-moderate, and moderate-to-severe intrauterine adhesions were 81%, 66%, and 32%, respectively.

Once intrauterine adhesions are suspected, hysteroscopy is the preferred examination. Ultrasound hysterography or hysterography can also help demonstrate the extent of scarring. We can perform corresponding adhesion dissolving surgery at the same time as hysteroscopy to restore the volume and shape of the uterine cavity. At the same time, we can reduce the incidence of recurrence by placing IUDs, balloons, amniotic membranes, hyaluronic acid, etc. after the operation. Even so, the recurrence rate after surgery for intrauterine adhesions is still 3%-24%, and some reports even show a recurrence rate of 63%.

Intrauterine adhesion is so terrible, so how should we prevent it? First of all, we should reduce intrauterine operations as much as possible and perform surgical treatments when conditions permit. For example, if you can choose medical abortion, try to avoid surgical abortion. Secondly, blind intrauterine operations can be minimized and performed under ultrasound guidance to reduce damage to normal tissues. Finally, strictly follow the standard operating procedures and instruct patients to take strict contraceptive measures after surgery to avoid secondary surgery in a short period of time.