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Asherman's SyndromeFrom: Dr Siri Karunatilleka (drsirind@x-stream.co.uk)Tue Oct 12 16:53:30 1999
To: ob-gyn-l@obgyn.net From: Dr S De Silva FRCOG [drsirind@x-stream.co.uk] Subject: Asherman’s Syndrome 12th October 1999 Primigravida,34yrs, had a SVD 18 months ago. Postnatal she had heavy loss from six weeks onwards for four weeks. US pelvic scan showed no placental remnants; beta-HCG negative; she was given a course of antibiotics, on presumption of sepsis. Bleeding abated, but recurred heavier four weeks later; a different antibiotic was given inspite of negative clinical signs and symptoms. Bleeding continued heavier than before. She saw a second gynaecologist and had a curettage done at 12 weeks postnatal. Bleeding stopped within a week. Has not resumed menses since, though breast-feeding stopped at twelve weeks postnatal. Hormone profile confirms regular ovulation; prolactin and thyroid hormones normal; Pelvic scan shows ?thin endometrium,not diagnostic of Asherman’s. Attempt at salpingogram failed due to stenosis of cervical canal. She has seen a third gynaecologist, experienced in TCR and intra-uterine surgery. He confirms Asherman’s, But has advised IU surgery is hazardous and complication rate could be high. She is symptomless apart from the amenorrhoea,which does not worry the patient. She is not keen on a pregnancy at present, but future desires not well defined. Are the risks of IU adhesiolysis worth taking in her situation? She is not sure whether she will desire another pregnancy later. What are the chances of regrowth of endometrium after 12 months of amenorrhoea? What are US scan feautures diagnostic of IU adhesions? How will you manage this patient? Shall be very grateful for your views.
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