Uterine Synechia: A Preliminary Communication on an Attempted Treatment of the Condition with Intrauterine Instillation of Autologous Bone Marrow Mononuclear Cells

  • Niranjan Bhattacharya
  • Sushanta Kumar Banerjee
  • Dhruba Malakar
Chapter

Abstract

The uterine cavity is lined by the endometrium. This lining is composed of two layers, the functional layer (adjacent to the uterine cavity) which is shed during menstruation and an underlying basal layer (adjacent to the myometrium) which is necessary for regenerating the functional layer. Thorough curettage and removal/partial removal of the basal layer often leads to a condition known as synechia, or Asherman’s syndrome (AS) or Fritsch syndrome, where there is intrauterine adhesion of the walls of the uterus, as a result of which the estrogen-sensitive areas are lost leading to a condition where patients experience secondary menstrual irregularities characterized by a decrease in flow and duration of bleeding (amenorrhea, hypomenorrhea, or oligomenorrhea).

Keywords

Catheter Estrogen Tuberculosis Progesterone Perforation 

Notes

Acknowledgment

The Department of Science and Technology, Government of West Bengal, supported the investigator with a research grant during his tenure at Bijoygarh State General Hospital from 1999 to 2006. The work started in Bijoygarh Government Hospital (1999–2006) and was followed up at Vidyasagore Government Hospital subsequently. The author gratefully acknowledges the support of the patients who volunteered for this research work. The guidance of Prof. K. L. Mukherjee of Biochemistry and Prof. M. K. Chhetri, former Director of Health Services, is acknowledged.

References

  1. 1.
    Klein SM, Garcia C-R. Asherman’s syndrome: a critique and current review. Fertil Steril. 1973;24(9):722–35.PubMedGoogle Scholar
  2. 2.
    Valle RF, Sciarra JJ. Intrauterine adhesions: hystreoscopic diagnosis, classification, treatment and reproductive outcome. Am J Obstet. 1988;158(6Pt1):1459–70.CrossRefGoogle Scholar
  3. 3.
    Buttram VC, Turati G. Uterine synechiae: variations in severity and some conditions which may be conducive to severe adhesions. Int J Fertil. 1977;22(2):98–103.PubMedGoogle Scholar
  4. 4.
    Krolikowski A, Janowski K, Larsen JV. Asherman syndrome caused by schistosomiasis. Obstet Gynecol. 1995;85(5Pt2):898–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Bukulmez O, Yarali H, Gurgan T. Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis. Hum Reprod. 1999;14(8):1960–1.PubMedCrossRefGoogle Scholar
  6. 6.
    Fernandez H, Al-Najjar F, Chauvenaud-Lambling A, et al. Fertility after treatment of Asherman’s syndrome stage 3 and 4. J Minim Invasive Gynecol. 2006;13(5):398–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Roge P, D’ercole C, Cravello L, Boubli L, Blanc B. Hysteroscopic management of uterine synechiae: a series of 102 observations. Eur J Obstet Gynecol Reprod Biol. 1996;65(2):189–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Capella-Allouc S, Morsad F, Rongieres-Bertrand C, et al. Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod. 1999;14(5):1230–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Deaton JL, Maier D, Andreoli J. Spontaneous uterine rupture during pregnancy after treatment of Asherman’s syndrome. Am J Obstet Gynecol. 1989;160(5Pt1):1053–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Yu D, Wong YM, Cheong Y, Xia E, Li TC. Review Asherman syndrome – one century later. Fertil Steril. 2008;89(4):759–79.PubMedCrossRefGoogle Scholar
  11. 11.
    Salamonsen LA. Review tissue injury and repair in the female human reproductive tract. Reproduction. 2003;125(3):301–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. Stem Cells. 2007;25:2082–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Gargett CE, Masuda H. Review adult stem cells in the endometrium. Mol Hum Reprod. 2010;16(11):818–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Gargett CE, Masuda H. Adult stem cells in the endometrium. Mol Hum Reprod. 2010;16(11):818–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Niranjan Bhattacharya
    • 1
  • Sushanta Kumar Banerjee
    • 2
  • Dhruba Malakar
    • 3
  1. 1.Regenerative Medicine and Transplant ScienceColcatta School of Tropical MedicineKolkataIndia
  2. 2.Health of Family WelfareSwasthya Bhavan, Govt. of West BengalKolkataIndia
  3. 3.Animal Biotechnology CentreNational Dairy Research InstituteKarnalIndia

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