What should I do if uterine adhesions occur after abortion?

Intrauterine adhesion is a gynecological disease that often occurs in women, especially those who frequently undergo abortions or women who have given birth. The possibility of intrauterine adhesion is greater, so preventive measures should be taken in daily life, such as maintaining good hygiene and avoiding uterine infection as much as possible. So, what are the current scientific treatments for intrauterine adhesions that occur after abortion?

What should I do if uterine adhesions occur after abortion?

Surgical separation of adhesions

Hysteroscopic uterine adhesion separation (TCRA) is a standard method to separate or remove intrauterine adhesions in a targeted manner under direct vision, so that patients can resume normal menstruation and improve pregnancy and delivery outcomes after surgery. There are mainly mechanical surgery and energy instrument surgery, the purpose of which is to restore the normal shape of the uterine cavity, expose the uterine horns and fallopian tube openings on both sides, and reduce damage to the residual endometrium.

(1) Hysteroscopic scissors separation method

Use flexible semi-rigid scissors or rigid scissors to separate adhesions from the center of the uterine cavity to expand the uterine cavity. When the uterine cavity is completely closed, separation should be carried out from the internal cervical os until a new uterine cavity is opened and the uterine cornu is freed. If there are extensive adhesions, be alert to uterine perforation. The advantages of hysteroscopic scissor excision are:

① Mechanical separation of adhesions can provide a good sign, especially for adhesions close to the myometrium. Bleeding can be observed when cutting into the myometrium, reminding the surgeon to stop cutting and avoid uterine perforation.

② When adhesions are extensive, the normal healthy endometrium is less, and it is important to preserve the normal endometrium. The scissor excision method does not cause scar formation and damage to the normal endometrium caused by electrical or laser excision. The disadvantage is that it is sometimes difficult to operate when using semi-rigid scissors, especially when cutting adhesions on the posterior wall. If the scissors do not bite well, the adhesions may not be cut sharply enough.

(2) Hysteroscopic resection

IUA separation is performed by using needle-shaped or ring-shaped electrodes. However, due to the stenosis and occlusion of the uterine cavity caused by severe adhesions, the uterine cavity expansion field is small, and the electrosurgical operation is very difficult. If you are not careful, it is easy to cause uterine perforation and damage to adjacent organs. When using a forward-tilted ring electrode to directly separate or remove adhesions, it is difficult to determine where the adhesions start during the operation. The boundary mark between the adhesions and the uterine muscle may disappear. When the cut is deep, part of the endometrium is scraped off when separating the adhesions. Therefore, it is necessary to pay attention to the scars caused by electrical energy and the damage to the adjacent normal endometrium. The adhesion bands in the uterine cavity generally have no blood vessels, but when cutting into the uterine myometrium, small blood vessel bleeding will occur. Electrocoagulation can be used to stop the bleeding, and at the same time remind the surgeon to stop cutting. The use of needle electrodes for hysterotomy is suitable for the treatment of dense scarring of intrauterine adhesions, which results in a narrow uterine cavity. For those who are amenorrhea, a needle electrode is used to make 4 to 5 cuts along the long axis of the uterus to expand the uterine cavity. The menstrual cycle is restored under postoperative hormone therapy. Uterine adhesions cause the uterine cavity to deform and narrow, especially in cases of uterine cavity atresia. Surgical operations are difficult and uterine perforation is likely to occur. Therefore, it is best to use laparoscopy and ultrasound combined monitoring during surgery.