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Case Studies | Gynaecology | India | Volume 13 Issue 4, April 2024
Severe Asherman Syndrome: Secondary Amenorrhoea, Hysteroscopic Management Followed by Fruitful Pregnancy: A Case Report
Dr. Nandini Chakrabarti Bhattacharyya | Dr. Ritwik Ghosh Haldar
Abstract: Introduction: Asherman Syndrome occurs when scar tissue forms inside the uterus & or cervix. Primarily occurs following D & E performed for elective termination of pregnancy, a missed or incomplete miscarriage or for retained placenta after delivery with or without hemorrhage, less often it results after D & C for non-obstetrical procedure for excessive bleeding, sampling for endometrial biopsy, removal of endometrial polyps or myomectomy. Deliberate endometrial ablation is done to create scarring to control bleeding in HMB. In developing country it may occur in infections like schistosomiasis or tuberculosis. Aims & Objectives: The chances of conception & delivery after surgery are lower in patients with moderate to severe disease but may improve post-surgery if the uterine cavity can be reconstructed & menses resume. A normal appearing uterine cavity may be seen after repeated surgeries but resumption of normal appearing endometrial lining may lag behind after surgery or may not recur at all. Asherman Syndrome can result in recurrent miscarriages /pregnancy loss despite surgery and treatment. Recurrence of adhesions can be seen even after adhesiolysis. Hysteroscopic adhesiolysis may be a game changer in this scenario and can bring smiles to the subfertile couples. Materials & Methods: In this case TVS and hysteroscopy were used to diagnose Asherman's syndrome after proper hormonal assay to rule out other causes of subfertility. Hysteroscopic Adhesiolysis was done to reconstruct the Uterine cavity. Tubal patency was confirmed by laparoscopic dye test & later on by HSG. Results: Our patient was fortunate enough to conceive after hysteroscopic adhesiolysis ,despite moderate to severe adhesions with secondary amenorrhoea for 6 months. Discussion & Conclusion: Asherman?s Syndrome can result in obstetric complications like Pre-term labour, Low birth weight and placental complications including retained placenta & Placenta Accreta Spectrum(PAS). Our patient was a victim of PPROM at 31 weeks. Primary prevention of Asherman Syndrome stems from Public Awareness Programme about contraception with KAP (Knowledge Attitude Practice) & promotion of Medical Method of Abortion. Although Dilatation and Curettage is the most frequent method of removing Retained Product of Conception, hysteroscopic removal causes minimal damage. Thus diagnosis & management of Asherman Syndrome requires interdisciplinary co-ordination of Gynaecological Endoscopic Surgeon, Radiologist & Obstetrician along with Neonatologist.
Keywords: Asherman Syndrome, Hysteroscopy, Synaechiolysis, PPROM
Edition: Volume 13 Issue 4, April 2024,
Pages: 726 - 729