Intrauterine synechia (Asherman's syndrome) - connective tissue changes in the uterine cavity leading to its full or partial fusion.
Causes of Synechia
The main reason for the formation of synechia are the injuries of the basal layer of the endometrium, obtained by mechanical action. Most often, such violations are the result of scraping after childbirth and abortion. The most traumatic is the first four weeks after such procedures.
Also, the appearance of synechia in the uterus can be facilitated by other surgical interventions (metroplasty, myomectomy, mucosal diagnostic curettage) and intrauterine administration of medications, including contraceptives.
Secondary factors are acquired infection and inflammation.
The emergence of intrauterine synechia is most affected by patients with a dead pregnancy. The remains of placental tissue are able to induce the activation of fibroblasts and promote the formation of collagen even before the regeneration of the endometrium. With repeated miscarriages, the likelihood of developing synechia increases.
In women who have not been subjected to intrauterine manipulation in the past, the cause of synechia becomes chronic endometritis.
Synechia in the uterus - symptoms
In general, the symptoms depend on the degree of infection of the uterus. There is a definite classification of synechia, characterizing the disease, depending on the degree of spread and the state of tightening of the uterus.
- I degree - about 1/4 of the volume of the uterine cavity is occupied, the sinuses are thin, the mouth of the pipes and the bottom are free;
- II degree - 1/4 - 3/4 of the uterine cavity is occupied, there is no adherence of the walls, there are only adhesions, the mouth of the pipes and the bottom are not completely closed;
- III degree - more than 3/4 of the volume of the uterine cavity is taken.
The main symptoms are pain in the lower abdomen, which during menstruation intensify. The nature of the discharge also changes, they become scarce and short-lived.
Painful sensations depend on the location of the synechiae. If the fissures are in the lower part of the uterus in the region of the cervical canal, they prevent normal blood flow and the feeling of pain is particularly severe. Thus, it is possible to form hematomas and complete cessation of menstruation. When menstruation goes without problems, women almost do not experience pain. The most severe consequences of synechia are infertility and miscarriage. Significant fusion of the uterine cavity prevents the movement of the sperm to the egg. Also, the affected endometrium does not allow the fertilized egg to adhere to the uterine wall, since the mucosa is replaced by a connective tissue.
Diagnosis of synechia in the uterine cavity is performed with hysterosalpingography, hysteroscopy and ultrasound.
Intrauterine synechia - treatment
The only method used today is surgical intervention, since it is possible to effectively treat the synechia possibly
The nature of the operation and its results depend on the extent of the spread of the synechia in the uterus and its adhesion. The removal of thin synechia is possible with the hysteroscope body or with scissors and forceps. Dense spikes are removed gradually by an electron knife or laser conductor.
As preoperative preparation and postoperative adaptation in the treatment of synechia in the uterine cavity, medicamentous drugs are used that create a reversible atrophy of the endometrial tissue for a smaller growth before the operation, and then restore and promote healing.