Pregnancy

Pregnancy

Women who underwent hysteroscopic adhesiolysis showed significant improvement in the menstrual pattern and increased rates of conception as well as live birth rate per conception. Recurrence of intrauterine adhesions is an important consideration while performing adhesiolysis and adequate precautions must be taken. The use of repeat procedures and adhesion prevention strategies are needed. Also, a meta-analysis, taking into considerations all the research conducted about this syndrome is required to achieve a better understanding of this disease.

Joseph Asherman defined Asherman’s syndrome in 1948 as a case of severe intrauterine adhesions secondary to trauma to gravid uterus. Specifically, he identified this pathology in 29 women who showed amenorrhea with stenosis of internal cervical ostium. Pregnant uterus is more susceptible to develop scarring but any trauma even in non-pregnant state to the endometrium can cause intrauterine adhesions. Today, this terminology encompasses all cases of intrauterine permanent adhesions which obliterate, partially or completely, the uterine cavity, irrespective of the cause. Other than trauma to gravid uterus, the etiological factors leading to Asherman’s syndrome are mullerian duct malformation, genital tuberculosis, insertion of intrauterine device and uterine surgery like caesarian section, diagnostic curettage, myomectomy, hysteroscopy surgery, etc.

The patients of intrauterine adhesions (IUA) generally present with amenorrhea or other menstrual aberrations, recurrent pregnancy loss and infertility. It is also important to underline that there are many cases reported in the literature where presence of interauterine adhesions is not associated with any symptoms. Pregnancy after IUAs may be complicated by abortion, premature labor, placenta previa and placenta accreta.

During the last two decades, the advent of hysteroscopy has revolutionized the diagnosis and management of Asherman’s syndrome. Historically, the use of hysterosalpingography (HSG) has been widespread in the diagnosis but hysteroscopy is now the gold standard of diagnosis and treatment of Asherman’s syndrome.

Asherman’s syndrome is a condition with a high impact on female reproduction. In the past, many studies have been performed to evaluate reproductive outcome in cases of Asherman’s syndrome. In previous report by Yu et al., hysteroscopic adhesiolysis achieved successful anatomical restoration in 57.8% to 97.5% of cases. They reported adhesion reformation (3.1 to 23.5%) to be the major limiting step to success of the treatment which warranted repeat procedures.

However, there is scanty data in Indian scenario regarding Asherman’s syndrome and its type of presentation, severity of adhesions, recurrence and impact on menstrual pattern. The nature of disease presentation in Indian subcontinent is distinguished by different incidence of etiological factors especially genital tuberculosis. Studies have shown that genital tuberculosis seems to be associated with recurrence of IUA and poor prognosis after hysteroscopic surgery.

The present study aimed to analyze the outcome of hysteroscopic adhesiolysis in 60 women with Asherman’s syndrome by observing the stage of disease, reestablishment of cavity, post-operative menstrual pattern and pregnancy rates.

'