Asherman's syndrome primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Saud Khan M.D.
Overview
No primary prevention exists for Asherman's syndrome.
Primary Prevention
Asherman's is not usually caused by an 'over-aggressive' D&C: a properly performed D&C can lead to Asherman’s. Medical alternatives to D&C for evacuation of retained placenta/products of conception exist including misoprostol methotrexate and mifepristone. Studies show this less invasive and cheaper method to be to be efficacious, safe and an acceptable alternative to surgical management for most women.[1] [2]. It was suggested as early as in 1993 [3] that the incidence of IUA might be lower following medical evacuation (eg. Misoprostol) of the uterus, thus avoiding any intra-uterine instrumentation. So far, one study supports this proposal, showing that women who were treated for missed miscarriage with misoprostol did not develop IUA, while 7.7% of those undergoing D&C did [4]. The advantage of misoprostol is that it can be used for evacuation not only following miscarriage, but also following birth for retained placenta or hemorrhaging.
Alternatively, D&C could be performed under ultrasound guidance rather than blind procedure. This would enable the surgeon to end scraping the lining when all retained tissue has been removed, avoiding injury.
Early monitoring during pregnancy to identify miscarriage can prevent the development of, or as the case may be, the reoccurence of Asherman’s as adhesions are more likely to occur after a D&C the longer the period after fetal death [5]. Therefore immediate evacuation following fetal death may prevent IUA.
The use of hysteroscopic surgery instead of D&C to remove retained products of conception or placenta is another alternative, although it could be ineffective if a lot of tissue is present. Also, hysteroscopy is not a widely or routinely-used technique and requires expertise.
There is no data to indicate that suction D&C is less likely than sharp curette to result in Asherman's. A recent article describes three cases of women who developed intrauterine adhesions following manual vacuum aspiration.[6]
References
- ↑ Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM (2005). "National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial.A comparison of medical management with misoprostol and surgical management for early pregnancy failure". N Engl J Med. 353 (8): 761–9. PMID 16120856.
- ↑ Weeks A, Alia G, Blum J, Winikoff B, Ekwaru P, Durocher J, Mirembe F. (2005). "A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion". Obstet Gynecol. 106 (3): 540–7. PMID 16135584.
- ↑ Friedler S, Margalioth EJ, Karfka I, Yaffe H. (1993). "Incidence of post-abortionintrauterine adhesions evaluated by hysteroscopy-a prospective study". Hum Reprod. 8 (3): 442–444. PMID 8473464.
- ↑ Tam WH, Lau WC, Cheung LP, Yuen PM, Chung TK. (2002). "Intrauterine adhesions after conservative and surgical management of spontaneous abortion". J Am Assoc Gynecol Laparosc. 9 (2): 182–185. doi:10.1016/S1074-3804(05)60129-6. PMID 11960045.
- ↑ Friedler S, Margalioth EJ, Kafka I, Yaffe H. Incidence of postabortion intra-uterine adhesions evaluated by husteroscopy: a prospective study. Hum Reprod 1993;8:442-444.
- ↑ Dalton VK, Saunders NA, Harris LH, Williams JA, Lebovic DI (2006). "Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure". Fertil. Steril. 85 (6): 1823.e1–3. doi:10.1016/j.fertnstert.2005.11.065. PMID 16674955.