Effects of Asherman Syndrome on Maternal and Neonatal Morbidity with Evaluation by Conception Method

Abstract

Create a comprehensive summary of maternal and neonatal morbidities from patients previously treated for Asherman syndrome and evaluate for differences in perinatal outcomes based on conception method. Design: Retrospective cohort. Setting: Community teaching hospital affiliated with a large academic medical center. Patients: Total of 43 singleton births identified from 40 patients previously treated at our institution for Asherman syndrome. Interventions: Review of fertility and obstetric data to summarize the maternal and neonatal outcomes in singleton births from patients with Asherman syndrome who had been treated with hysteroscopic adhesiolysis. Measurements and Main Results: Primary outcomes of maternal morbidity (i.e., hypertensive disease, gestational diabetes, ruptured membranes, postpartum hemorrhage, morbidly adherent placenta [MAP]) and secondary outcomes of neonatal morbidity (i.e., gestational age at birth, method of delivery, weight, length, 1-and 5-minute Apgar score oxygen requirement, anatomic malformations, length of neonatal admission) were evaluated. We identified 40 patients who completed successful treatment of Asherman syndrome and went on to carry a singleton gestation within our institution: 20 (50%) with mild disease, 18 (45%) with moderate disease, and 2 (5%) with severe disease under the March classification system. In total, 43 singleton births were examined, with 27 of 43 (62.8%) conceived without in vitro fertilization (IVF) (group A: non-IVF conception) and 16 of 43 (37.2%) conceived through IVF (group B: IVF conception). The overall rate of preterm birth in Asherman pregnancies was 11.6%, with no difference between the 2 conception groups. We documented 9.3% cases with intrauterine growth restriction, with no difference based on conception groups. The rate of MAP in patients with Asherman syndrome was 14.0%, and the rate of postpartum hemorrhage was 32.6%, with no differences between the conception groups. Newborn anatomic malformations of any cause were documented in 18.6% of all singleton births, with no difference between the conception groups. Conclusion: Our series indicates a higher incidence of intrauterine growth restriction, MAP, postpartum hemorrhage, and newborn anatomic malformations in Asherman syndrome pregnancies than that reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of patients with Asherman syndrome who conceived with or without IVF after being treated with hysteroscopic adhesiolysis.

Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions

“… Intrauterine adhesions (IUAs) [ 10 , 33 ] The complication of the wound in the uterine cavity or the trauma to the endometrium caused by termination of pregnancy, placement of an intrauterine device (IUD), dilatation and curettage (D&C), cesarean section, or infection/irradiation [ 34 ]. 3.6% of polyp removal, 6.7% of resection of uterine septa, 21.6% of myomectomy, 37.6% of abortion evacuation curettage [ 35 , 36 ]; Moderate or severe IUAs: causing oligomenorrhea, amenorrhea, even infertility and severe obstetric complications including placenta previa and placenta implantation [ [40] , [41] , [42] ]; Asherman's syndrome (uterine cavity is completely occluded): causing amenorrhea and infertility [ 43 ]; Influencing women's physical and mental health. High rates (23% for moderate adhesion and 62% for severe adhesion) for incidence of recurrent adhesion [ [37] , [38] , [39] ].…”

“…Moderate or severe IUAs: causing oligomenorrhea, amenorrhea, even infertility and severe obstetric complications including placenta previa and placenta implantation [ [40] , [41] , [42] ];…”

Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report

“…In terms of its effect on pregnancy, in particular, Asherman’s syndrome is responsible for high rates of infertility, miscarriage, implantation failure during assisted reproduction, and placental abnormalities[ 6 - 8 ]. We considered that our patient had developed severe Asherman’s syndrome due to repeated D&C for a hydatidiform mole and persistent trophoblastic disease.…”