Abstract
Uterine synechiae, or intrauterine adhesions (IUA), are often underdiagnosed but can lead to infertility and abnormal menstruation. They most commonly occur after uterine instrumentation. Often, the underlying pathophysiology is damage to the basilar endometrium [1]. This results in fibrous connective tissue bands that may have glandular tissue [2]. Synechiae range from minimal adhesions to total obliteration of the uterine cavity. Adhesions can be filmy or dense. Most often, they are located in the cavity but can also occur in the cervicoisthmic area. On histology, adhesions can be fibromuscular, endometrial, myometrial, or connective tissue. The worst prognosis is seen with dense fibrous adhesions without endometrial glands [2].
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References
Fedele L, Bianchi S, Frontino G. Septums and synechiae: approaches to surgical correction. Clin Obstet Gynecol. 2006;49(4):767–88.
Berman J. Intrauterine adhesions. Semin Reprod Med. 2008;26(4):349–55.
Lobo R, Gershenson D, Lentz GM, Valea FA. Comprehen Gynecol. 2017:837–88.
Golan A, Raziel A, Pansky M, Bukovsky I. The role of manual removal of the placenta in forming intrauterine adhesions. J Am Assoc Gynecol Laparosc. 1995;2(Suppl 4):S18.
Capella-Allouc S, Morsad F, Rongier-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod. 1999;14(5):1230–3.
Fernandez H, Capmas P, Nazac A. Uterine synechiae after hysteroscopic myomectomy: should we use bipolar or monopolar energy? J Minim Invas Gynecol. 2016;23(Suppl):S1–252.
March CM. Management of Asherman’s syndrome. Reprod Biomed. 2011;23:63–76.
Salazar CA, Isaccson K, Morris S. A comprehensive review of Asherman’s syndrome: causes, symptoms and treatment options. Curr Opin Obstet Gynecol. 2017;29(4):249–56.
Dmowski WP, Greenblatt RB. Asherman’s syndrome and risk of placenta accreta. Obstet Gynecol. 1969;34:288–99.
Panayotidis C, Weyers S, Bosteels J, van Herendael B. Intrauterine adhesions (IUA): has there been progress in understanding and treatment over the last 20 years? Gynecol Surg. 2009;6:197–211.
AAGL Elevating Gynecologic Surgery. AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE). Gynecol Surg. 2017;14:6.
March CM, Israel R, March AD. Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol. 1978;130:653–7.
Wamsteker K, De Blok SJ. Diagnostic hysteroscopy: technique and documentation. Endos Surg Gynecol. 1995:263–76.
Nasr AL, Al-Inany H, Thabet S, Aboulghar M. A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Investig. 2000;50:178–81.
The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.
Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158:1459–70.
Donnez J, Nisolle M. Hysteroscopic lysis of intrauterine adhesions (Asherman syndrome). In: Donnez J, editor. Atlas of laser operative laparoscopy and hysteroscopy. New York: Parthenon; 1994. p. 305–22.
Socolov R, Anton E, Butureanu S, Socolov D. The endoscopic management of uterine synechiae: a clinical study of 78 cases. Chirurgia. 2010;105:515–8.
Ikeda T, Morita A, Imamura A, Mori I. The separation procedure for intrauterine adhesions (synechia uteri) under roentgenographic view. Fertil Steril. 1981;36:333–8.
Johary J, Xue M, Zhu X, et al. Efficacy of estrogen therapy in patients with intrauterine adhesions: systematic review. J Minim Invasive Gynecol. 2014;21:44–54.
Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome: one century later. Fertil Steril. 2008;89:759–79.
Cai H, Qiao L, Song K, He Y. Oxidized, regenerated cellulose adhesion barrier plus intrauterine device prevents recurrence after adhesiolysis for moderate to severe intrauterine adhesions. J Minim Invasive Gynecol. 2017;24:80–8.
Tsapanos VS, Stathopoulou LP, Papathanassopoulou VS, Tzingounis VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res. 2002;63(1):10–4.
Acunzo G, Guida M, Pellicano M, et al. Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod. 2004;19:1461–4.
Lin X, Wei M, Li TC, et al. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):512–6.
Santamaria X, Cabanillas S, Cervello I, et al. Autologous cell therapy with CD133+ bone marrow-derived stem cells for refractory Asherman’s syndrome and endometrial atrophy: a pilot cohort study. Hum Reprod. 2016;31(5):1087–96.
Yu D, Li TC, Huang X, et al. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome. Fertil Steril. 2008;89(3):715–22.
Roy KK, Baruah J, Sharma JB, et al. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome. Arch Gynecol Obstet. 2010;281:355–61.
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Matevossian, K., Cholkeri, A. (2021). Uterine Synechiae and Postoperative Care. In: Tandulwadkar, S., Pal, B. (eds) Hysteroscopy Simplified by Masters. Springer, Singapore. https://doi.org/10.1007/978-981-15-2505-6_17
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