Intrauterine Adhesions (Asherman syndrome)
What is are intrauterine adhesions?
Adhesions are bands of scar tissue that can form in the body. In the uterus (womb), these scars are caused by injuring the deep layer of the endometrium (the lining of your womb). Uterine adhesions can form blockages, and prevent the endometrium from responding to hormones normally.
It is also known as Asherman syndrome or Intrauterine synechiae
What causes adhesions?
Most women will recall a previous surgery, procedure or infection in the uterus.
Dilation and Curettage (D&C)
o This is particularly a problem when done for pregnancy complications due to theeffect of pregnancy hormones on the uterus.
Surgical removal of fibroids, particularly those inside the uterus (submucosal fibroids).
Pregnancy complications & management eg. Extensive bleeding, infection, caesarean section
Infection eg. endometritis, tuberculosis
Pelvic radiotherapy
Endometrial ablation
How can adhesions be prevented?
Since the underlying cause is damage to the deep layer of the endometrium, any surgical procedures performed within the uterus should be done with precision and care. My surgical technique is focused on minimising damage to the endometrium.
Pregnancy complications following adhesions?
Despite treatment to remove adhesions, there is still an increased risk of miscarriage, pre-term birth, and abnormal placenta attachment. Pregnancy rates following surgery are approximately 50% and depend on how much endometrium was affected in the first place.
How do we treat adhesions?
Adhesions need to be removed surgically. This is done via a hysteroscope, a long thin telescope that is passed through the vagina and into the uterus. This allows me to see the entire cavity of the uterus and remove any adhesions. Afterwards, a hormone regime is needed to encourage the endometrium to regrow. Adhesions can recur in up to 50% of cases, therefore it is important to have a repeat hysteroscopy to clear away any new adhesions while they are still fresh.