How to check whether there is uterine adhesion?

Intrauterine adhesion is a common gynecological disease in clinical practice. The cause of the disease is often related to uterine trauma. In addition, it is also related to women's pregnancy. After the occurrence of intrauterine adhesions, the patient's body will show obvious symptoms, including menstrual abnormalities or infertility. So the question is, how to check whether there is adhesion in the uterine cavity medically?

1. Hysterosalpingography

Hysterosalpingography (HSG) is the first-line screening method for intrauterine adhesions. It can clearly identify intrauterine adhesions, but cannot show endometrial fibrosis and sparse adhesion bands. The filling defects formed by mucus and debris may cause certain false positives.

2. Transvaginal Ultrasound

Transvaginal ultrasound (TVS) is an effective method for diagnosing intrauterine adhesions. It can clearly determine the location and degree of adhesions and the thickness of the endometrium. It is a non-invasive examination with a sensitivity of 52% and a specificity of only 11%.

3. Hysteroscopy

Sonohysterography (SHG): Combined with vaginal ultrasound and intrauterine injection of 20-30 ml of 0.9% sodium chloride solution (normal saline), the presence of intrauterine adhesions, the degree of adhesion, and the location of adhesions can be determined based on the acoustic characteristics. Its accuracy is better than that of simple vaginal ultrasound. It is an effective method when vaginal ultrasound examination is normal but intrauterine adhesions are highly suspected.

4. Magnetic resonance

Magnetic resonance imaging (MRI) can show the condition of the endometrium above the cervical canal, and is an auxiliary diagnostic method, especially for those with complete cervical atresia who cannot undergo hysteroscopy.

5. Hysteroscopy

Hysteroscopy is the gold standard method for diagnosing intrauterine adhesions and is also an effective treatment method.

Causes

Endometrial damage is a necessary condition for intrauterine adhesions, and its causes are miscarriage, infection and iatrogenic injury.

(1) During pregnancy, the uterus becomes fragile, and the endometrium and the underlying layer are more easily injured; after pregnancy surgery (including abortion, curettage, etc.), the estrogen level decreases, affecting endometrial hyperplasia. Uterine injury during pregnancy (accounting for 90%), including abortion (induced abortion, incomplete/missed abortion), postpartum hemorrhage, retained placenta, cesarean section and gestational trophoblastic disease trauma.

(2) Intrauterine adhesions may also occur during other non-pregnancy periods, such as during diagnostic curettage. Occurs during the non-pregnancy period: after curettage, myomectomy, cervical biopsy or polypectomy, and after radium irradiation. Patients who have undergone hysteroscopic surgery, such as mediastinectomy, submucosal myomectomy, bilateral uterine artery embolization, and uterine artery ligation for postpartum hemorrhage.

(3) Infection: The most common infection is endometrial tuberculosis. Chronic or subacute endometritis may also lead to intrauterine adhesions.

(4) Others: Related to abnormal development of the Müllerian duct, especially septate uterus.

(5) Genetic factors: The disease is related to genetic factors.