Jayasuriya Ramakrishn*, Sinega Boopathy, Arun Kumar Kolanjinathan, Tursunova Veronika Davidbekovna, John Rose Viju


Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman’s
syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and
the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the
prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal
layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after
hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive
contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy.
Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are
classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and
localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and
scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods.
Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the
central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the
prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine
devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the
prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or
curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this
review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature
search with a wide range of search terms.

Keywords: Asherman’s syndrome, genital adhesions, intrauterine synechia, gynatresia.

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