The management of Asherman syndrome in gynecology
Abstract
Asherman syndrome is an acquired condition characterized by the formation of adhesions in the uterine cavity. This condition is often caused by trauma to the endometrium, which mostly happens after currettage or post-partum, and can produce several complications such as menstrual disturbances, infertility, or recurrent abortion. The management of Asherman syndrome requires complete actions which can be summarized with the acronym PRACTICE, consisting of prevention, anticipation, comprehensive therapy, timely surveillance of subsequent pregnancies, investigation and continuing education. The prevention and anticipation aspects can be performed through reduction of invasive methods of therapy such as currettage, prophylactic therapy for adhesions such as antibiotics and post-estrogen therapy for high risk patients, and the use of instruments that do less damage to the uterine walls. The comprehensive therapy that become the method of choice is operative lysis using hysteroscopy, which provides direct visualization of the adhesion. To prevent reccurrence, especially to patients planning to have subsequent pregnancies, timely surveillance of the next pregnancies for high risk patients should be performed at hospital, with complete work-ups. Lastly, evaluation of operative results and continuing education to explain prognoses to the patient should be also performed. (Med J Indones. 2013;22:121-6)
Downloads
References
Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome-one century later. Fertil Steril 2008;89(4):759-79.
Myers EM, Hurst BS. Comprehensive management of severe Asherman syndrome and amenorrhea. Fertil Steril 2012;97(1): 160-4.
March CM. Management of Asherman's syndrome. Reprod Biomed Online. 2011;23(1): 63-76.
Fritz MA, Sperrof L. Female infertility. In: Fritz MA, Speroff L, editors. Clinical gynecologic endocrinology and infertility, 8th ed. Philadelphia (PA): Lipincott Williams & Wilkins;2011.
Poujade O, Grossetti A, Mougel L, Ceccaldi P, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage. BJOG 2011;118(4):433-9.
Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2010;117(1):84-93.
Burney RO, Schust DJ, Yao MWM. Infertility. In: Berek JS, editor. Berek & Novak's gynecology, 14th ed. Philadelphia (PA): McGraw-Hill co.;2007. p.1050.
Berman JM, Intrauterine adhesions. Semin Reprod Med. 2008;26(4):349-55
March CM. Acquired intrauterine adhesions: Asherman's syndrome. In: Adashi, EY, Rock JA, Rosenwaks Z., editor. Reproductive endocrinology, surgery and technology. Philadelphia (PA): Lippincott-Raven;2006.1474-87
Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005;353(8):761-9.
Smith LFP, Ewings PD, Quinlan C. Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term followup of miscarriage treatment (MIST) randomised controlled trial. BMJ. 2009;339:b382.
Fontanarosa M, Galiberti S, Fontanarosa N. Fertility after non-surgical management of the symptomatic spontaneous first-trimester abortion. Minerva Ginecol. 2007;59(6):591-4.
Sentilhes L, Ambroselli C, Kayem G, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod. 2010;25(11): 2803-10.
Dankert T, Vleugels M. Hysteroscopic resection of retained placental tissue. A feasibility study. Gynecol Surg. 2008;5:121- 4.
Wolman I, Altman E, Fait G, et al. Evacuating retained products of conception in the setting of an ultrasound unit. Fertil Steril 2009;91:1586-8.
Mavrelos D, Ben-Naji J, Davies A, Lee C, Salim R, Jurkovic D. The value of pre-operative treatment with GnRH analogues in women with submucous fibroids: a double blind, placebo controlled randomized trial. Hum Reprod. 2010;25(9):2264-9.
Pujade O. Grosetti A, Mougel L, Ceccaldi PF, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in themanagement of major postpartum haemorrhage. BJOG. 2011;118(4):433-9.
Azziz, R. Role of reproductive surgeons and the Society of Reproductive Surgeons. Fertil Steril 2002;78(5):916-7.
Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003;82(1):49-56.
Fernandez H, Peyrelevade S, Legendre G, Faivre E, Deffieux X, Nazac A. Total adhesions treated by hysteroscopy: must we stop at two procedures?. Fertil Steril 2012;98(4):980-5.
Dwyer BK, Belogolovkin V, Tran L, et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?. J Ultrasound Med. 2008;27(9):1275-81.
American Association of Gynecologic Laparoscopists. Practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010;17:1.
Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertil Steril 2008;89(3):715-22.
Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. Arch Gynecol Obstet. 2010; 281(2):355-61.
Copyright (c) 2013 Wachyu Hadisaputra, Yohanes Handoko
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
