Development of Asherman syndrome after conservative surgical management of intractable postpartum hemorrhage

Abstract

Objective-Describe a case of secondary infertility due to the development of severe Asherman Syndrome after the B-Lynch compression suture and uterine artery ligation, and to review the BLynch technique and documented complications. Design-Case report.Setting-Tertiary care hospital. Patient(s)-A 29-year-old primigravida patient. Intervention(s)-B-Lynch suture and uterine artery ligation. Main Outcome Measure(s)-Development of Asherman syndrome.Result(s)-Development of secondary infertility due to Asherman syndrome after the B-Lynch suture. Conclusion(s)-The B-Lynch suture is a highly successful conservative surgical technique used to treat this condition. There is little information regarding any potential for compromised future fertility, although there have been several reports of successful pregnancy after the use of the BLynch compression suture. In this report, we present a case of Asherman syndrome with complete obliteration of the uterine cavity after the B-Lynch suture.

Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique?

“…However, the possibility of an abnormal hysteroscopic finding does not appear to be restricted to the use of HMSS. Such complications have been previously described as a possible consequence of other uterine-sparing procedures (9,10). Amenorrhea possibly related to uterine synechia can also occur after pelvic arterial embolization, representing 5% to 22% of cases (11)(12)(13).…”

B-Lynch: A Technique for Uterine Conservation or Deformation? A Case Report with Literature Review

“…Rathat G et al, followed 37 post uterine compression suture patients and found that 7 had synechia of varying degrees, with three of them having severe synechia which was akin to Asherman's syndrome [11]. One nearly similar isolated case of Asherman's syndrome which occurred after B-Lynch and vessel ligation done for postpartum haemorrhage, has been reported by Goojha et al, [12]. Akoury and Sherah reported a patient who required both B-Lynch and Cho compressive sutures, who developed uterine synechia in the early post operative period and for which synechial lysis was done hysteroscopically.…”

Does uterine artery ligation, performed because of a severe postpartum hemorrhage, alter fertility?

“…In the first series, no amenorrhea or synechia was reported on the 20 women who underwent a bilateral uterine artery ligation whether or not associated with utero-ovarian ligament ligation (7); and in the second series, Asherman syndrome occurred in a woman who underwent both bilateral uterine artery ligation and B-Lynch suture (8).…”

“…Second, in order to support the opinion that TUAL may be a risk factor of synechia, the authors mentioned inadequately two previous studies where no synechia was found following TUAL alone (7,8).…”