Asherman's syndrome causes
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Editor(s)-in-Chief: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Canan S Fornusek, Ph.D.; Associate Editor-In-Chief: Saud Khan M.D.
Overview
Asherman's syndrome is most commonly linked to obstetric procedures that cause abrasion of the basal layer of the endometrium. Other causes include caesarian sections, infections or pelvic radiation therapy.
Intrauterine devices have not been linked to Asherman's syndrome.
Causes
Asherman's syndrome occurs most frequently after a Dilation & Curettage (D&C) is performed on a recently pregnant uterus, following a missed or incomplete miscarriage, birth, or elective termination (abortion) to remove retained products of conception/placental remains. As the same procedure is used in all three situations, Asherman's can result in all of the above circumstances. It affects women of all races and ages as there is no underlying predisposition or genetic basis to its development. According to a study on 1900 patients with Asherman’s syndrome, over 90% of the cases occurred following pregnancy-related curettage [1].
It is estimated that up to 5% of D&Cs result in Asherman's. More conservative estimates put this rate at 1%. Asherman's results from 25% of D&Cs performed 1-4 weeks post-partum [2][3][4], 30.9% of D&Cs performed for missed miscarriages and 6.4% of D&Cs performed for incomplete miscarriages. [5] In the case of missed miscarriages, the time period between fetal demise and curettage increases the likelihood of adhesion formation to over 30.9% [1][6]
Asherman's can also result from other pelvic surgeries including Cesarean section[7], removal of fibroid tumours (myomectomy) and from other causes such as IUDs, pelvic irradiation, schistosomiasis[8] and genital tuberculosis[9]. Chronic endometritis from genital tuberculosis is a significant cause of severe IUA in the developing world, often resulting in total obliteration of the uterine cavity which is difficult to treat [10].
References
- ↑ 1.0 1.1 Schenker JG, Margalioth EJ. (1982). "Intra-uterine adhesions: an updated appraisal". Fertility Sterility. 37 (5): 593–610. PMID 6281085.
- ↑ Parent B, Barbot J, Dubuisson JB. Uterine synechiae (in French). Encyl Med Chir Gynecol 1988; 140A (Suppl): 10-12.
- ↑ Rochet Y, Dargent D, Bremond A, Priou G, Rudigoz RC (1979). "The obstetrical outcome of women with surgically treated uterine synechiae (in French)". J Gynecol Obstet Biol Reprod. 8 (8): 723–726. PMID 553931.
- ↑ Buttram UC, Turati G. (1977). "Uterine synechiae: variation in severity and some conditions which may be conductive to severe adhesions". Int J Fertil. 22 (2): 98–103. PMID 20418.
- ↑ Adoni A, Palti Z, Milwidsky A, Dolberg M. (1982). "The incidence of intrauterine adhesions following spontaneous abortion". Int J Fertil. 27 (2): 117–118. PMID 6126446.
- ↑ Fedele L, Bianchi S, Frontino G. Septums and synechiae: approaches to surgical correction. Clin Obstet Gynecol 2006; 49:767-788.
- ↑ Rochet Y, Dargent D, Bremond A, Priou G, Rudigoz RC (1979). "The obstetrical outcome of women with surgically treated uterine synechiae (in French)". J Gynecol Obstet Biol Reprod. 8 (8): 723–726. PMID 553931.
- ↑ Krolikowski A, Janowski K, Larsen JV. (1995). "Asherman syndrome caused by schistosomiasis". Obstet Gynecol. 85 (5Pt2): 898–9. doi:10.1016/0029-7844(94)00371-J. PMID 7724154.
- ↑ Netter AP, Musset R, Lambert A Salomon Y (1956). "Traumatic uterine synechiae: a common cause of menstrual insufficiency, sterility, and abortion". Am J Obstet Gynecol. 71 (2): 368–75. PMID 13283012.
- ↑ Bukulmez O, Yarali H, Gurgan T. (1999). "Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis". Hum Reprod. 14 (8): 1960–1961. doi:10.1093/humrep/14.8.1960. PMID 10438408.