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Genital tuberculosis: an important cause of Asherman’s syndrome in India

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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To demonstrate the association between genital endometrial tuberculosis and Asherman's syndrome.

Materials and methods

A total of 28 women who underwent hysteroscopy with or without laparoscopy for suspected Asherman’s syndrome from symptoms (amenorrhoea or oligomenorrhoea, and or primary or secondary infertility) and who were found to have genital tuberculosis on endometrial biopsy (histopathology or culture) or positive polymerase chain reaction (PCR) on endometrial aspirate or positive findings of tuberculosis on laparoscopy or hysteroscopy were enrolled in this retrospective study.

Results

The mean age and parity were 26.5 years and 0.3, respectively. There was past history of TB in 67.8% women. All women had menstrual dysfunction, with oligomenorrhoea and hypomenorrhoea in 16 (57%) women and amenorrhoea in 12 (42.8%). All women had primary (n = 19, 67.8%) or secondary (n = 9, 32%) infertility. On hysteroscopy, there were various grades of adhesions in all women, with grade I in 17.8%, grade II in 28.5%, grade III in 28.5% and grade IV in 17.5% women. Only four women (14.3%) had open ostia, while others had bilateral (28.5%) or unilateral (21.3%) blocked ostia or inability to see ostia (28.5%). On laparoscopy performed on 18 women, there were varying grades of adhesions in 16 (88.8%) women, with beading (33.3%), tubercles (33.3%), caseation (11.1%) and tubo-ovarian masses (11.1%). The diagnosis of genital TB was made by histopathology (tuberculous granuloma) on endometrial biopsy in 28.6%, positive culture in 3.6%, positive polymerase chain reaction (PCR) in 46.4% and observation of tubercles, beading or caseation on laparoscopy in 17.8% or shaggy cavity with caseation on hysteroscopy in 3.6% women.

Conclusion

Genital tuberculosis appears to be an important and common cause of Asherman's syndrome in India, causing oligomenorrhoea or amenorrhoea with infertility.

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References

  1. WHO report on the TB epidemic (1994) TB, a global emergency. WHO/TB/94.177, World Health Organisation, Geneva

  2. Dye C, Watt CJ, Bleed DM, Hosseini SM, Raviglione MC (2005) Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence and deaths globally. JAMA 293:2767–2775

    Article  PubMed  CAS  Google Scholar 

  3. World Health Organisation (2006) Global tuberculosis control: surveillance, planning, financing. WHO/HTM/TB, World Health Organisation, Geneva, p 362

  4. Sharma JB (2007) Female genital tuberculosis revisited. Obstet Gynaecol Today XII:61–63

    Google Scholar 

  5. Schaefer G (1976) Female genital tuberculosis. Clin Obstet Gynaecol 19:223–239

    Article  CAS  Google Scholar 

  6. Kumar S (2001) Female genital tuberculosis. In: Sharma SK, Mohan A (eds) Tuberculosis, 1st edn. Jaypee, Delhi, pp 311–324

  7. Gupta N, Sharma JB, Mittal S, Singh N, Misra R, Kukreja M (2007) Genital tuberculosis in Indian infertility patients. Int J Gynaecol Obstet 97(2):135–138, Epub, 23 Mar 2007

    Article  PubMed  CAS  Google Scholar 

  8. Sharma JB, Malhotra M, Arora R (2003) Fitz Hugh Curtis syndrome as a result of genital tuberculosis: a report of three cases. Acta Obstet Gynecol Scand 82(3):295–297

    Article  PubMed  Google Scholar 

  9. Bazaz Malik G, Maheshwari B, Lal N (1983) Tuberculosis endometritis: a clinicopathological study of 1,000 cases. Br J Obstet Gynaecol 90:84–86

    PubMed  CAS  Google Scholar 

  10. Asherman JG (1960) The myth of tubal and endometrial transplantation. Br J Obstet Gynecol 67(2):228–233

    CAS  Google Scholar 

  11. Neuwirth RS (1993) Gynecologic surgery and adhesion prevention: Asherman’s syndrome. Prog Clin Biol Res 381:187–190

    PubMed  CAS  Google Scholar 

  12. Westendorp IC, Ankum WM, Mol BW, Vonk J (1998) Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Human Reprod 13(12):3347–3350

    Article  CAS  Google Scholar 

  13. Schenker JG (1996) Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol 65(1):109–113

    Article  PubMed  CAS  Google Scholar 

  14. Smid A, Borsos A, Takacs I (1980) Aetiology of Asherman’s syndrome (intra-uterine synechia). Zentralbl Gynakol 102(7):380–385

    PubMed  CAS  Google Scholar 

  15. Schiaff WD, Hurst BS (1995) Preoperative sonographic measurement of endometrial pattern predicts outcome of surgical repair in patients with severe Asherman’s syndrome. Fertil steril 63(2):410–413

    Google Scholar 

  16. Bacelar AC, Wilcock D, Powell M, Worthington BS (1995) The value of MRI in the assessment of traumatic intra-uterine adhesions (Asherman’s syndrome). Clin Radiol 50(2):80–83

    Article  PubMed  CAS  Google Scholar 

  17. Cohen MA, Sauer MV, Keltz M, Lindheim SR (1999) Utilising routine sonohysterography to detect intrauterine pathology before initiating hormone replacement therapy. Menopause 6(1):68–70

    Article  PubMed  CAS  Google Scholar 

  18. Sciarra JJ (1997) Simplified therapy for Asherman’s syndrome. Fertil Steril 68(6):1047–1050

    Article  Google Scholar 

  19. Broome JD, Vancaillie TG (1999) Fluoroscopically guided hysteroscopic division of adhesions in severe Asherman syndrome. Obstet Gynaecol 93(6):1041–1043

    Article  CAS  Google Scholar 

  20. Magos A (2002) Hysteroscopic treatment of Asherman’s syndrome. Reprod Biomed Online 4(Suppl 3):46–51

    PubMed  Google Scholar 

  21. March CM, Isreal R, March AD (1978) Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol 130:653

    PubMed  CAS  Google Scholar 

  22. Wamsteker K (1984) Hysteroscopy in Asherman’s syndrome. In: Siegler AM, Lindemann HJ (eds) Hysteroscopy: principles and practice. Lippincott, Philadelphia, pp 198–203

    Google Scholar 

  23. American Fertility Society (1988) The American Fertility Society of adnexal adhesions, distal tubal occlusions, secondary to tubal ligation, tubal pregnancy, mullerian anomalies and intrauterine adhesions. Fertil Steril 49:944–955

    Google Scholar 

  24. Valle RF, Sciarra JJ (1988) Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment and reproductive outcome. Am J Obstet Gynecol 158:1459–1470

    PubMed  CAS  Google Scholar 

  25. Donnez J, Nisolle M (1994) Hysteroscopic lysis of intrauterine adhesions (Asherman’s syndrome). In: Donnez J (ed) Atlas of laser operative laparoscopy and hysteroscopy. Parthenon Pub Group, London, pp 305–322

    Google Scholar 

  26. Newton JR, Mackenzie WE, Emens MJ, Jordan JA (1989) Division of uterine adhesions (Asherman’s syndrome) with the Nd-YAG laser. Br J Obstet Gynaecol 96(1):102–104

    PubMed  CAS  Google Scholar 

  27. Fernandez H, Al-Najjar F, Chauveaud-Lambling A, Frydman R, Gervaise A (2006) Fertility after treatment of Asherman’s syndrome stage 3 and 4. J Minim Invasive Gynecol 13(5):398–402

    Article  PubMed  Google Scholar 

  28. Shiau CS, Hsieh CC, Chiang CH, Hsieh TT, Chang MY (2005) Intrapartum spontaneous uterine rupture following uncomplicated resectoscopic treatment of Asherman’s syndrome. Chang Gung Med J 28(2):123–127

    PubMed  Google Scholar 

  29. Jindal UN (2006) An algorithmic approach to female genital tuberculosis causing infertility. Int J Tuber Lung Dis 10:1045–1050

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

    Jai Bhagwan Sharma, Kallol K. Roy, M. Pushparaj, Nupur Gupta, Sunesh Kumar Jain, Neena Malhotra & Suneeta Mittal

  2. AI 161, Azad Apartments, Sri Aurobindo Marg, New Delhi, 16, India

    Jai Bhagwan Sharma

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  1. Jai Bhagwan Sharma
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  2. Kallol K. Roy
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  3. M. Pushparaj
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  4. Nupur Gupta
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  5. Sunesh Kumar Jain
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  6. Neena Malhotra
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  7. Suneeta Mittal
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Correspondence to Jai Bhagwan Sharma.

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Sharma, J.B., Roy, K.K., Pushparaj, M. et al. Genital tuberculosis: an important cause of Asherman’s syndrome in India. Arch Gynecol Obstet 277, 37–41 (2008). https://doi.org/10.1007/s00404-007-0419-0

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  • DOI: https://doi.org/10.1007/s00404-007-0419-0

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