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Uterine Synechiae

Uterine Synechiae is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • 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
    • Important to classify severity because it has prognostic value for fertility (1)[C]
    • Each system includes consideration of adhesion characteristics on hysteroscopy. Currently, no single uniform system is endorsed, thus difficult to compare studies.

Epidemiology

Incidence
1.5% of all hysterosalpingographies


Prevalence
  • 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.

Risk Factors

  • 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
    • Polypectomy
    • Intrauterine device (IUD) insertion
    • Myomectomy
    • Postpartum hemorrhage
    • Recurrent SABs
    • Pelvic infection (e.g., endometrial tuberculosis or pelvic inflammatory disease)—controversial

General Prevention

  • Minimize intrauterine operative interventions while women are fertile and desire pregnancy.
  • Expectant or medical management rather than surgical management of SABs

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Citation

Stephens, Mark B., et al., editors. "Uterine Synechiae." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117588/all/Uterine_Synechiae.
Uterine Synechiae. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117588/all/Uterine_Synechiae. Accessed April 21, 2019.
Uterine Synechiae. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117588/all/Uterine_Synechiae
Uterine Synechiae [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117588/all/Uterine_Synechiae.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Uterine Synechiae ID - 117588 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117588/all/Uterine_Synechiae PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -