The Diagnosis and Management of Asherman’s Syndrome Developed after Cesarean Section and Reproductive Outcome

Intrauterine adhesions (IUAs) frequently occur as a result of trauma to the basal layer of endometrium following pregnancy-related curettage such as incomplete abortion (33,3%), postpartum hemorrhage (37,5%), and elective abortion (8,3%). Hysterotomy, myomectomy, Cesarean section, hysteroscopic procedures, such as resection of submucosal leiomyomata or uterine septae, and endometrial ablation are less common etiologic factors resulting in IUA formation. Patients with Asherman’s syndrome usually present with menstrual disturbances, infertility, or recurrent pregnancy loss. A successful treatment of infertility could be achieved by restoration of the uterine cavity, prevention of IUA reformation, and promotion of healing process. We presented the diagnosis and management of a case that suffers from menstrual disturbances and secondary infertility resulted from IUA formation developed after Cesarean section.

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Endometrial Regeneration in Asherman's Syndrome: Clinical and Translational evidence of Stem Cell Therapies

Current Stem Cell Research & Therapy ◽

10.2174/1574888x14666190213100528 ◽

2019 ◽

Vol 14 (6) ◽

pp. 454-459

Author(s):

Xuejing Hou ◽

Ying Liu ◽

Isabelle Streuli ◽

Patrick Dällenbach ◽

Jean Dubuisson ◽

...

Keyword(s):

Stem Cell ◽

Molecular Mechanisms ◽

Uterine Cavity ◽

Stem Cell Therapies ◽

Intrauterine Adhesions ◽

Asherman’S Syndrome ◽

Cell Therapies ◽

Fibrotic Process ◽

Physical Barriers

Asherman’s Syndrome or Intrauterine adhesions is an acquired uterine condition where fibrous scarring forms within the uterine cavity, resulting in reduced menstrual flow, pelvic pain and infertility. Until recently, the molecular mechanisms leading to the formation of fibrosis were poorly understood, and the treatment of Asherman’s syndrome has largely focused on hysteroscopic resection of adhesions, hormonal therapy, and physical barriers. Numerous studies have begun exploring the molecular mechanisms behind the fibrotic process underlying Asherman’s Syndrome as well as the role of stem cells in the regeneration of the endometrium as a treatment modality. The present review offers a summary of available stem cell-based regeneration studies, as well as highlighting current gaps in research.

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Experience of application anti adgesivebarrier in the treatment of patients with Asherman’s syndrome

Journal of obstetrics and women s diseases ◽

10.17816/jowd65529-32 ◽

2016 ◽

Vol 65 (5) ◽

pp. 29-32

Author(s):

Tatyana A Makarenko ◽

Daria E Nikiforova ◽

Inga O Ul’yanova

Keyword(s):

Uterine Cavity ◽

Intrauterine Adhesions ◽

Asherman’S Syndrome ◽

Surgical Interventions ◽

Results Of Treatment ◽

Group I ◽

Extreme Degree ◽

Group Ii ◽

Research On Application ◽

Prevention Of Recurrence

Relevance. Asherman’s syndrome is one of the most difficult problems in gynecologic practice, because in addition to complex clinical picture, which includes secondary amenorrhea and infertility is a significant difficulty in diagnosis and treatment. The purpose was to improve the results of treatment of Аsherman’s syndrome after conducting hysteroresectoscope adhesiolysis using anti adhesive barrier “Antiadgezin”.Materials and methods. The study included 36 patients with peritoneal process in the uterus of varying severity. Group I consisted of 20 women who are in the postoperative period in the uterine cavity was entered “Antiadgezin”, group II — 16 women with similar pathology without introducing anti adgesive barriers.Results. All women 3 months after adhesiolysis was performed a control hysteroscopy. The presence of adhesions was diagnosed in 2 (10%) patients in the first group, while adhesions were isolated delicate and easily destroyed by the sheath of a hysteroscope. In group II adhesions had recurrences in 5 (31,3%) patients (p = 0,038), and one patient was visualized “tunnel” — uterus, which is extremely unfavorable course of disease.Conclusion. Treatment of Asherman’s syndrome, as extreme degree of intrauterine adhesions, requires a comprehensive approach, which is based on prevention of recurrence of the formation of adhesions after surgical interventions. Research on application anti adgesivebarriers will continue, as intrauterine their use on the example of antiadgezin showed good results.

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Role of hyaluronic acid intrauterine injection in the prevention of Asherman’s syndrome in women undergoing uterine septum resection: An RCT

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v19i4.9060 ◽

2021 ◽

Author(s):

Seiede Zahra Ghanadzadeh Tafti ◽

Atiye Javaheri ◽

Razieh Dehghani Firoozabadi ◽

Samane Kabirpour Ashkezar ◽

Hossein Falahzadeh Abarghouei

Keyword(s):

Hyaluronic Acid ◽

Uterine Cavity ◽

Control Group ◽

Case Group ◽

Intrauterine Adhesions ◽

Double Blind ◽

Asherman’S Syndrome ◽

Uterine Septum ◽

Acid Gel ◽

American Society

Background: Adhesion due to intrauterine surgery such as septal resection associated with damaged endometrium can increase the risk of Asherman’s syndrome. The main goal of treatment in this syndrome is to repair the damaged endometrium for creating a physiological pregnancy. Objective: To investigate the effect of intrauterine injection of hyaluronic acid on the prevention of Asherman’s syndrome in women undergoing uterine septum resection. Materials and Methods: In this double-blind randomized clinical trial, 65 women undergoing the uterine septum resection were divided into two groups; the case group (n = 34) and the control group (n = 31). Immediately after the septal resection with a resectoscope, 1cc of hyaluronic acid gel in the case group and 1cc normal saline solution as a placebo in the control group was injected into the uterine cavity. After two months, existence of intrauterine adhesions in the both groups was examined by the hysteroscope and assessment of menstrual patterns, according to the American Society for Reproductive Medicine criteria. Results: Our results showed that after intervention, the incidence of Asherman’s syndrome in the control group was higher than the case group (p = 0.012). In the case group, only four women had poor adhesion (Asherman’s syndrome) at the end of the study, while the rest of them were free of any adhesions in the uterine cavity. In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms. Conclusion: The results of the study exhibited the hyaluronic acid capacity to reduce the risk of Asherman’s syndrome in women with endometrial damage following a septal resection surgery. Key words: Asherman’s syndrome, Septum, Uterine, Hyaluronic acid, Resection.

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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

Journal of obstetrics and women s diseases ◽

10.17816/jowd66612-19 ◽

2017 ◽

Vol 66 (6) ◽

pp. 12-19 ◽

Cited By ~ 2

Author(s):

Arseniy S. Molotkov ◽

Eduard N. Popov ◽

Dmitriy S. Sudakov ◽

Tatyana A. Aivazyan ◽

Lyudmila A. Alexandrova ◽

...

Keyword(s):

Chloride Solution ◽

Comparison Group ◽

Uterine Cavity ◽

Main Group ◽

Uterine Bleeding ◽

Intraoperative Blood Loss ◽

Intrauterine Adhesions ◽

Asherman’S Syndrome ◽

Inflammatory Reactions ◽

Pelvic Peritoneum

Introduction. One of the leading problems of modern reproductive surgery is treatment of adhesive disease, and in turn, prevention of intrauterine adhesions after intrauterine interventions is of particular interest. Purpose: to evaluate the effectiveness and safety of anti-adhesive gel “Antiadgesin” for intrauterine use in patients with a combination of pathology of the uterine cavity and severe forms of endometriosis. Materials and methods. The study included 24 patients aged 23 to 39 years with a combination of pathology of the uterine cavity and severe forms of genital endometriosis. The main group consisted of 12 patients to whom the anti-adhesive gel “Antiadhesin” was applied at the end of the laparoscopic and hysteroscopic stages on the region of the ovaries, pelvic peritoneum in the areas of separation of the adhesions, and also inside the uterine cavity. The comparison group included 12 patients who received 0.9% sodium chloride solution (5 ml) on the surgical area. Patients of both groups underwent treatment with gonadotropin-releasing hormone agonists (GnRH-a) 3.75 mg for 4 months after the operation. We performed gynecological ultrasound 4 weeks after operation, 4 weeks after the last injection of GnRH-a, and after the first menstrual bleeding. Assessment of the state of the uterine cavity, diagnosis of intrauterine synechia was performed by hydrosonography. Results. The duration of the operation, the amount of intraoperative blood loss did not differ significantly between the groups. In all patients, no complications of the postoperative period, no allergic or inflammatory reactions associated with the use of “Antiadhesin” were detected. The duration the uterine bleeding after the operation did not differ significantly between the groups. In 2 patients of the comparison group hydrosonography confirmed the adhesive pathology of the uterine cavity. In the main group there were not identified any signs of intrauterine adhesions by ultrasound. Within 12 months after the treatment, pregnancy occurred in 50% of the patients in the main group and in 33.3% of the patients in the comparison group. Conclusion. The results of the study showed that the introduction of the anti-adhesive gel “Antiadgesin” in the uterine cavity after hysteroresectoscopy is a safe and effective method for preventing the formation of intrauterine synechia.

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Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

Journal of Pregnancy ◽

10.1155/2012/635683 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Katrine Fuglsang ◽

Margit Dueholm ◽

Estrid Stæhr-Hansen ◽

Lone Kjeld Petersen

Keyword(s):

Cesarean Section ◽

Postpartum Haemorrhage ◽

Placenta Previa ◽

Post Partum ◽

Transvaginal Ultrasound ◽

Uterine Cavity ◽

Intrauterine Adhesions ◽

Traditional Treatment ◽

Reproductive Capability ◽

Scar Healing

Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa.Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing.Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects.Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.

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Link between cesarean section (CS) delivery and secondary infertility. Uterine cavity evaluation in women undergoing fertility treatment using three dimensional (3D) saline infusion sono-hysterogaphy (SIS)

10.26226/morressier.5912d9ead462b80292385fad ◽

2017 ◽

Author(s):

Ghazala Basir

Keyword(s):

Cesarean Section ◽

Three Dimensional ◽

Uterine Cavity ◽

Saline Infusion ◽

Fertility Treatment ◽

Secondary Infertility

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Postpartum endometritis prevention in abdominal delivery planning in pregnant with severe anaerobic vaginal dysbiosis

Kazan medical journal ◽

10.17750/kmj2015-005 ◽

2015 ◽

Vol 96 (1) ◽

pp. 5-9 ◽

Cited By ~ 1

Author(s):

K V Voronin ◽

A M Alale ◽

I I Alale ◽

R M Banakhevich

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Vaginal Discharge ◽

Bacterial Flora ◽

Uterine Cavity ◽

Test System ◽

Control Group ◽

Study Group ◽

Septic Complications ◽

Ascending Infection

Aim. Prevention of purulent and septic complications in females after planned caesarean section.Methods. Out of 60 pregnant women, who underwent comprehensive examination during the trial, 35 (58.3%) were included in the study group and were delivered off by planned cesarean section; 25 (41.7%) pregnant women, included in the control group, were delivered off by urgent cesarean section. Considering the goal of the study, bacteriology of vaginal discharge, amniotic fluid and placental tissues, DNA detection of vaginal discharge bacterial flora before and after treatment (using «Femoflor-16» test system) according to classification by M.N. Boldyreva (2010), uterine cavity aspirate cytology according to classification by M.A. Kupert (2003), sonography of the uterus and uterine adnexa on the 4-5 day after the surgery according to classification of A.P. Milovanov were added to the training program for pregnant women. In the study group, pregnant patients with severe anaerobic vaginal dysbiosis at the 36-38 weeks of gestation were administered causal treatment of severe anaerobic vaginal dysbiosis, pregnant patients of the control group were not treated if severe anaerobic vaginal dysbiosis was diagnosed.Results. Performed correction of vaginal microbiota in the study group has significantly improved the course of postoperative period, reduced the incidence of uterine subinvolution, signs of chorioamnionitis as a manifestation of ascending infection compared to the control group. Postpartum endometritis has developed in 1 (2.8%) patient of the study group and in 5 (20.0%) cases in the control group. Offered method for preparing the patients with vaginal dysbiosis to cesarean section reduced the risk for postpartum endometritis by 6.8 times.Conclusion. Strategy of preparation for planned Caesarean section should include vaginal discharge bacteriology and treatment of severe anaerobic vaginal dysbiosis, which reduces the risk for postpartum endometritis by 6.8 times.

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