A 10-year review of the clinical presentation and treatment outcome of Asherman's syndrome at a center with limited resources

Abstract

Background:Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA.Aim:This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman's syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997–2006.Subjects and Methods:This is a retrospective study of cases of Asherman's syndrome managed at the UMTH over a 10-year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records' Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi-square and binary logistic regression were used for inferential statistics.Results:Asherman's syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy-associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley's catheter insertion and estrogen-progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent's related risk factors associated with the development of Asherman's syndrome.Conclusion:Asherman's syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman's syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored.

A prospective, randomized, controlled trial comparing two doses of oestrogen therapy after hysteroscopic adhesiolysis to prevent intrauterine adhesion recurrence

“…Post-operative oestrogen therapy has been widely used by many investigators to prevent recurrence of the adhesions (Chen et al, 1997;Fernandez et al, 2006;Liu et al, 2016;March and Israel, 1976;Pabuccu et al, 2008;Robinson et al, 2008;Roy et al, 2010;Takai et al, 2015;Thomason et al, 2007). The AAGL Practice Guideline recommended post-operative hormone therapy with oestrogen (Grade B evidence) but did not specify the dose of oestrogen to be used (AAGL, 2010).…”

Experience of intrauterine application of anti-adhesive gel based on hyaluronic acid in the prevention of Asherman's syndrome in patients with the pathology of the uterine cavity and severe forms of endometriosis

“…Основными клиническими проявлениями этой патологии выступают: альго-и дисменорея, гипоменорея, в тяжелых случаях -аменорея; формирование гематометры и/или гематосальпинкса. По дан-ным некоторых авторов, внутриматочные сра-щения у 61,5 % пациенток становятся причиной бесплодия [10]. Происходит это, по-видимому, в силу того, что расположенный рядом с сине-хией нормальный эндометрий может подвер-гаться атрофической трансформации [11].…”

Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage

“…The shortterm complications of miscarriage include lacerations of the cervix, haemorrhage, infections and uterine perforation. Intrauterine adhesions are the main long-term complications of miscarriage [1]. Clinical manifestations of intrauterine adhesions include periodic abdominal pain, hypomenorrhoea, amenorrhoea, infertility, recurrent spontaneous miscarriages, placental implantation and placental adhesions [2].…”