Intrauterine synechia or, as they are also called, Asherman’s syndrome - a partial or complete infection of the uterine cavity. This is not a disease of the labia, everything is much more serious. The male part of the population has a similar problem - the synechia of the foreskin.
There are traumatic, infectious and neuro-visceral theories of the occurrence of this problem. The main factor is trauma to the basal layer of the endometrium, which occurs after an abortion or childbirth and has a mechanical character. Infection is already a secondary factor. The most traumatic is the period of the first four weeks after an abortion or childbirth.
Quite often, intrauterine synechia appears in patients with a frozen pregnancy. It is in them, more often than in others, after curettage of the uterine cavity that the problem of synechia develops. This is due to the fact that the remainder of the placental tissue can cause activation of the formation of collagen and fibroblasts even before the endometrium is fully regenerated. Intrauterine synechia appears in 5-40 percent of patients with repeated miscarriages.
In addition, this problem can occur after surgical interventions in the uterus: metroplasty, myomectomy, or curettage of the mucosa for diagnostic purposes. Also, intrauterine synechia can even provoke an intrauterine contraceptive.
Symptoms
Depending on how much the uterine cavity is overgrown, hypomenstrual syndrome, amenorrhea and its consequence - infertility, miscarriage can occur . In the case when only the lower part of the uterus is overgrown, and in the upper part the endometrium functions normally, a hematometer can develop. Strong uterine overgrowth and a lack of a normal working endometrium can lead to difficulties with implantation of the fetal egg. Even slightly expressed intrauterine synechiae are the reasons for the ineffectiveness of fertilization.
One third of women suffering from intrauterine synechia will receive spontaneous miscarriages, the same number will give birth prematurely, and another third will have placental abnormalities (presentation or tight attachment). This means that pregnancy in patients with synechia should be considered as a considerable risk, complications are possible during pregnancy, childbirth and the postpartum period.
Treatment
To date, the only way to treat this problem can be called dissection of synechia under visual direct control by a hysteroscope. In this case, there should be no trauma to the endometrium in order to restore the normal menstrual cycle and fertility. The operation, its effectiveness and expected results can depend only on the type of synechia and the degree of occlusion of the uterine cavity.
The synechia located centrally can be divided using the hysteroscope body in a blunt way. In addition, they use endoscopic forceps and scissors, a hysteroresectoscope with an electrode.
Small synechiae are quite easily destroyed by forceps, scissors or the hysteroscope body. Synechiae with higher density are dissected gradually with scissors, until that moment, until the uterine cavity is restored to its normal form.
In order to get rid of dense fibrous synechiae, most often use a hysteroresectoscope with an electrode or a laser conductor. To prevent uterine perforation (which is very possible), the operation is best carried out under the control of ultrasound with unexpressed uterine occlusion and under laparoscopic control when the occlusion is significantly pronounced.
After dissection of the intrauterine synechia, pregnant girls are at risk. Indeed, in addition to the frequent inability to bear a child, there is still the threat of postpartum hemorrhage.