Grades of AS
Society for Hysteroscopy, 1989:
I – Thin or filmy adhesions easily ruptured by hysteroscope sheath alone, cornual areas normal;
II – Singular firm adhesions connecting separate parts of the uterine cavity, visualization of both tubal ostia possible, cannot be ruptured by hysteroscope sheath alone;
IIa – Occluding adhesions only in the region of the internal cervical OS. Upper uterine cavity normal;
III – Multiple firm adhesions connecting separate parts of the uterine cavity, unilateral obliteration of ostial areas of the tubes;
IIIa – Extensive scarring of the uterine cavity wall with amenorrhea or hypomenorrhea;
IIIb – Combination of III and IIIa;
IV – Extensive firm adhesions with agglutination of the uterine walls. Both tubal ostial areas occluded
Valle and Sciarra’s 1988 classification
Mild- Filmy adhesions composed of basal endometrium producing partial or complete uterine cavity occlusion;
Moderate – Fibromuscular adhesions that are characteristically thick, still covered by endometrium that may bleed on division, partially or totally occluding the uterine cavity;
Severe – Composed of connective tissue with no endometrial lining and likely to bleed upon division, partially or totally occluding the uterine cavity.
Donnez and Nisolle 1994 classification
I – Central adhesions
- a) thin filmy adhesions (endometrial adhesions)
- b) myofibrous (connective adhesions)
II – Marginal adhesions (always myofibrous or connective)
- a) wedge like projection
- b) obliteration of one horn
III – Uterine cavity absent on HSG
- a) occlusion of the internal os (upper cavity normal)
- b) extensive agglutination of uterine walls (absence of uterine cavity – true Asherman’s)
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