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- Uterine synechiae are intrauterine adhesions (IUAs).
- Symptoms may include secondary amenorrhea, pelvic pain, recurrent spontaneous abortions (SABs), and/or infertility in a female of childbearing age.
- When specific symptoms are present, it is called Asherman syndrome: IUAs are associated with menstrual disturbances (amenorrhea, hypomenorrhea, or dysmenorrhea), infertility, and/or recurrent SABs.
- Severity of symptoms ranges from mild to moderate to severe, depending on the degree of adhesions (e.g., number, density, thickness, quality).
- Seven different classification systems to categorize disease severity
1.5% of all hysterosalpingographies
- Varies with geography, population profile, availability of diagnostic devices
- Asymptomatic population: 0.3% incidental finding of uterine adhesions
- After postpartum curettage: 22%
- After postabortion curettage: 37%
Etiology and Pathophysiology
- Endometrial injury stimulates fibrosis. See “Risk Factors” for specific types of injury.
- Fibrous tissue replaces endometrial stroma and glands; replacing normal, vascular tissue with denser, less vascular tissue
- Eventually, endometrial lining becomes atrophic and inert.
- 90% of cases result from curettage such as:
- Diagnostic curettage
- Postabortion curettage
- Postpartum curettage especially >48 hours postpartum
- Other risk factors include the following:
- Cesarean section
- Pelvic radiation
- Intrauterine device (IUD) insertion
- Postpartum hemorrhage
- Recurrent SABs
- Pelvic infection (e.g., endometrial tuberculosis or pelvic inflammatory disease)—controversial
- Minimize intrauterine operative interventions while women are fertile and desire pregnancy.
- Expectant or medical management rather than surgical management of SABs