Intrauterine adhesions can vary in forms, such as filmy adhesions, dense adhesions, and complete uterine cavity occlusion. These adhesions or occlusion can result in infertility, recurrent miscarriage, hypomenorrhea, or even amenorrhea.
Causes and Risk Factors
The most common cause of intrauterine adhesions is injury following a surgical procedure involving the cavity of the uterus (endometrial damage). Patients have usually been exposed to one of these risk factors:
1. Intrauterine procedures such as uterine curettage, hysteroscopic myomectomy, and hysteroscopic resection of uterine septum
2. Abdominal myomectomy
3. Missed abortion, incomplete abortion, and retained placenta
4. Endometritis or endometrial infection
1. History examination for such risk factors
2. Ultrasonography to find thin endometrium during ovulation
3. Hysterosalpingography to find abnormalities in uterine cavity
4. Hysteroscopy as a gold standard to examine intrauterine adhesions
Hysteroscopic lysis of adhesions is a standard treatment for intrauterine adhesions. This treatment aims to help maintain a normal cavity to prevent reoccurrence of the symptom, as well as to ensure functionality of the endometrium and fertility. Following cutting of the adhesions, a Foley balloon catheter will be temporarily placed inside the uterus to keep the walls of the uterus apart and to decrease the chance of adhesions reforming. Hormonal treatment with is often prescribed after surgery to stimulate recovery of the endometrium. In severe cases, it may be necessary to have more than one surgery to remove adhesions using hysteroscopy.
Fertility rate varies based on severity of intrauterine adhesions prior to the surgery.Patients with severe adhesions or extensive destruction of the endometrial lining may have a higher risk of complications such as intrauterine growth restriction, preterm delivery, abnormal adherent placenta, or abnormal adherent placenta.
Infertility in patients sometimes are resulted from intrauterine adhesions. Such symptom can be diagnosed using ultrasonography, hysterosalpingography, and treated with hysteroscopy. After the surgery, if a patient gets pregnant, they need extensive care due to high risk of possible complications.
Obstetrician and Gynecologist, Reproductive Medicine
JETANIN Journal Vol.10 No.2