Asherman Syndrome, referred to as Joseph Asherman, which was first described in 1948, refers to the adhesion (synechia) in the intrauterine tissue.
Causes of Asherman Syndrome
Asherman syndrome, which can develop after uterine surgeries (myomectomy, caesarean etc.) and diagnostic abortions, is mainly the result of pregnancy-related interventions. Impaired pregnancy, incomplete abortion, optional termination of pregnancy, abortion for the postpartum placenta are more common after abortions. The risk also increases after the rest-brokerage attempt performed due to remaining parts after abortion. The risk will increase at the rate of increasing the number of voluntary abortions of the woman, and in the third abortion the probability of Asherman Syndrome reaches 30%. In the first four weeks after abortions for birth or pregnancy termination, intrauterine tissue is very susceptible to damage. If it is not mandatory, avoiding interventions in this period would be an appropriate clinical approach.
Infections that exist during or after the intervention will also increase the risk of adhesion.
Apart from these, tuberculosis bacilli coming from the lungs through the blood may also cause severe adhesion in the uterus.
Grading of Asherman Syndrome
Asherman Syndrome consists of thin and superficial bands in intrauterine tissue, the front and rear walls of the cavity can be graded until they are heavily adherent.
Complaints of Asherman Syndrome
Let’s first take a look at the complaints: The most common complaint is not having children. Pregnancy cannot occur due to intrauterine bands and endometrial tissue not developing sufficiently. Then there are complaints of not being menstrual or decreasing the amount of menstruation. Recurrent miscarriages are also closely related to Asherman Syndrome. The important thing is to raise the suspicion of Asherman Syndrome first. After suspecting the situation, it will be time to evaluate the diagnostic tools:
Diagnosis in Asherman Syndrome
Routine ultrasonography is not very helpful in diagnosis and its value is limited. Endometrium tissue may appear thinner than it should be on cycle day in routine ultrasonography. However, it can be monitored completely normal. This image is related to the severity of the adhesions. Ultrasound called sonohisterography after giving saline to the intrauterine tissue may be more useful. Three-dimensional imaging in ultrasonography is also useful for obtaining a suspicious image in terms of fly.
Medicated uterine film called hysterosalpingography is very useful. It will give clear clues about the areas and degree of adhesion.
Treatment in Asherman Syndrome
However, gold is the standard hysteroscopy in diagnosis. Hysteroscopic intervention will give the opportunity to cure at the same time with cessation of adhesions at the time of diagnosis. In hysteroscopy, office hysteroscopy can be performed without general anesthesia for women, and it is more convenient to perform under general anaesthesia in operating room conditions. Imaging of the intrauterine tissue and access to the correct area requires experience. The procedure can be performed under ultrasonography or laparosopic observation in severe adhesions. Adhesions inside the uterus are opened with pressurized fluid and generally with hysteroscopic sharp scissors.
Intrauterine device or balloon catheter can be left in the cavity to prevent re-formation of adhesions after surgery and to allow reconstruction of the intrauterine tissue called endometrium. However, its place in contemporary practice has decreased considerably. It will be appropriate to provide support for the structuring of the endometrium with estrogen treatment after hysteroscopic adhesiolysis.
Response to surgical and post-support treatments is all about the degree of adhesions before. In mild and superficial adhesions, the treatment response and subsequent healthy pregnancy development rate is very high, while in severe adhesions the same healing rates may not be achieved. In this case, after the first hysteroscopy session, adequate opening may not be achieved and a re-session can be done.
Pregnancies obtained after adhesion treatment, it will be appropriate to monitor closely for complications such as miscarriage risks, placental location anomalies.