OB-GYN-L Messages for October, 1999: Re: Asherman's Syndrome

Re: Asherman's Syndrome

From: Rafael Haciski MD

haciski@earthlink.net

Tue Oct 12 22:42:11 1999

Sonographically it is hard to visualize adhesions - best done with sonohysterography (thin IUI catheter inserted with sterile warm saline instilled while observing ultrasonographically) where you will note the cavity, with bands of tissue extending from side to side.

However, this does require that some cavity be present, and if the scarring is so severe that there is no cavity left, then I doubt that anything can be seen. This is very much what we achieve with endometrial ablation - the endometrium has been replaced with scar.

When ready to conceive, she should see a GYN who is experienced in repair of Asherman's; she will need to undergo repeated cycles of ...hysteroscopic resection of adhesions, followed by ...high dose estrogen treatment, and ...culminating in progesterone withdrawal Repeat hysteroscopy is then done to assess the progress and the process is repeated until cavity is open. This may take several such cycles, much time and agrevattion, but I do not think that much risk, beyond the usual hysteroscopic (and laparoscopic, if needed) complications, as well as the possible ill effects of high does estrogen.

-- Rafael Haciski, MD FACOG Gynecology & Infertility Associates Baltimore MD http://www.ivf-md.com

---------- >From: "Dr Siri Karunatilleka" <drsirind@x-stream.co.uk> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net> >Subject: Asherman's Syndrome >Date: Tue, Oct 12, 1999, 17:55 >

> 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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