Asherman's syndrome: current perspectives on diagnosis and management

被引:153
|
作者
Dreisler, Eva [1 ]
Kjer, Jens Joergen [1 ]
机构
[1] Univ Copenhagen, Dept Gynecol, Juliane Marie Ctr, Rigshosp, Dyssegaardsvej 76, DK-2870 Copenhagen, Denmark
来源
INTERNATIONAL JOURNAL OF WOMENS HEALTH | 2019年 / 11卷
关键词
Asherman's syndrome; genital adhesions; intrauterine synechia; gynatresia; MESENCHYMAL STEM-CELLS; HYALURONIC-ACID GEL; INTRAUTERINE ADHESIONS; HYSTEROSCOPIC ADHESIOLYSIS; REPRODUCTIVE OUTCOMES; ESTROGEN THERAPY; PREVENTION; PREVALENCE; WOMEN; HYSTEROSALPINGOGRAPHY;
D O I
10.2147/IJWH.S165474
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy. Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods. Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature search with a wide range of search terms.
引用
收藏
页码:191 / 198
页数:8
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