Management of Asherman’s syndrome

Abstract

Intrauterine adhesions (IUA) or Asherman's syndrome is a multifaceted condition which is being diagnosed with increasing frequency. Although it usually occurs following curettage of the pregnant or recently pregnant uterus, any uterine surgery can lead to IUA. Most women with IUA have amenorrhoea or hypomenorrhoea, but some have normal menses. Those who have amenorrhoea may also have cyclic pelvic pain secondary to 'trapped' menses and the accompanying retrograde menstruation may lead to endometriosis. In addition to menstrual disorders, most women with IUA will present with infertility or recurrent spontaneous abortion. Over the last four decades hysteroscopy has become the standard method to diagnose and treat this condition. Various techniques for adhesiolysis and for prevention of scar reformation have been advocated. The most efficacious appears to be the use of miniature scissors for adhesiolysis and the placement of a balloon stent inside the uterus immediately after surgery. Post-operative oestrogen therapy is prescribed in order to stimulate endometrial regrowth. Follow-up studies to assure resolution of the IUA are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for cervical incompetence, placenta accreta and intrauterine growth restriction.

Effect of stem cell application on Asherman syndrome, an experimental rat model

“…The incidence of Asherman syndrome has been rising over the last few decades due to increasing incidence of cesarean sections and uterine surgeries as well as the increased awareness and more detailed diagnostic approaches [1]. Thus, the treatment of this syndrome has also gathered a greater importance.…”

“…It can also be seen after postpartum or post cesarean section [1]. But most of the cases are related to curettage for pregnancy complications, such as missed or incomplete abortion, retained placental remnants or postpartum hemorrhage [2].…”

Endometrial stem cells repair injured endometrium and induce angiogenesis via AKT and ERK pathways

“…Intrauterine adhesions (IUAs) are common acquired endometrial disorders secondary to endometrial injury such as trauma, curettage, infection, uterine congenital anomaly and genetic predisposition (Yu et al 2008, March 2011. The incidence of IUAs has increased in recent years and 90% of IUAs are associated with damage to the uteri due to intrauterine surgery (Schenker & Margalioth 1982).…”

Review Article: Causes of Recurrent of Abortion

“…The harmful effects of occupational exposures on pregnant women had reported to indirectly expose fetus tooccupational hazards (11).Clearly, maternal exposure to occupational and/or environmental insults might have significant negative implications on pregnancy outcome. The available data on heavy metal toxicity such as lead, mercury; industrial pollutants such as dioxin, organic solvents, radiations; and some other component of lifestyle-associated factors such as tobacco smoking (active and passive) and excessive maternal intake of alcohol had adverse effect on pregnancy outcome.There are substantial scientific evidences that are supported by the fact that working women have a higher risk of RSA compared with nonworking women as they are more likely to be exposed to environmental insults (36).…”