Asherman syndrome

Asherman syndrome, also known as uterine synechiae, is a condition characterised by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium, and is often associated with infertility.

There is a tendency for the condition to develop soon after pregnancy (usually within four months 9). The incidence is thought to be increasing probably as a result of increased use of intrauterine interventions.

Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain 1.

Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring 1. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. genital tuberculosis).

The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.

Hysterosalpingogram

Intrauterine adhesions are typically seen on HSG as multiple irregular linear filling defects (may give a lacunar pattern), with the inability to appropriately distend the endometrial cavity 2. In severe cases, there can even be complete non-filling of the uterine cavity.

 Ultrasound

May be seen as hypoechoic bands traversing through the endometrial cavity. Sonohysterography may be useful for evaluation.

MRI

The adhesions are usually low signal on T2.

The goal of therapy is to remove adhesions and subsequently restore the normal size and shape of the uterine cavity. This is most commonly done by lysis of adhesions via hysteroscopy 3. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.

The condition was Initially described by Joseph Asherman in 1948 9.

On a hysterosalpingogram consider:

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Article information

rID: 12241
System: Gynaecology
Section: Syndromes
Synonyms or Alternate Spellings:
  • Uterine synechiae
  • Intrauterine adhesions
  • Asherman's Syndrome
  • Intrauterine adhesions (IUA)
  • Intrauterine adhesion bands
  • Intra-uterine adhesion bands

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Cases and figures

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    Case 1
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    Case 2
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    Case 3: adhesion band : mimicking a septate uterus
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    Case 4
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    Case 5
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