Asherman syndrome
Updates to Article Attributes
Asherman syndrome (AS),also known as uterine synechiae, is a condition characterised by the formation of intrauterine adhesions. It results, which are usually sequela from injury to the endometrium, and is often associated with infertility.
Epidemiology
There is a tendency for the condition to develop soon after a pregnancy (usually within 4four months 9). The incidence is thought to be increasing probably as a result of increased use of intrauterine interventioninterventions.
Clinical presentation
Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain 1.
Pathology
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.
Radiographic features
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.
Pelvic ultrasound Ultrasound
May be seen as hypoechoic bands traversing through the endometrial cavity. Sonohysterography may be useful for evaluation.
Pelvic MRI
The adhesions are usually low signal on T2.
Treatment and prognosis
The goal of treatmenttherapy 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.
History and etymology
The condition was Initially described by Joseph Asherman in 1948 9.
Differential diagnosis
On a hysterosalpingogram consider:
- normal intrauterine longitudinal folds in a nondistended uterus may sometimes mimic uterine synaechiae 4
See also
-
amniotic sheets: uterine synechiae
occuringoccurring in pregnancy - amniotic band syndrome
- intrauterine membrane in pregnancy
-<p><strong>Asherman syndrome (AS)</strong>,<strong> </strong>also known as <strong>uterine synechiae</strong>, is a condition characterised by formation of intrauterine adhesions. It results from injury to the <a href="/articles/endometrium">endometrium</a>, and is often associated with infertility.</p><h4>Epidemiology</h4><p>There is a tendency for the condition to develop soon after a pregnancy (usually within 4 months <sup>9</sup>). The incidence is thought to be increasing probably as a result of increased use of intrauterine intervention.</p><h4>Clinical presentation</h4><p>Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain <sup>1</sup>.</p><h4>Pathology</h4><p>Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring<sup> 1</sup>. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. <a href="/articles/tuberculous-pelvic-inflammatory-disease">genital tuberculosis</a>).</p><p>The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.</p><h4>Radiographic features</h4><h5>Hysterosalpingogram</h5><p>Intrauterine adhesions are typically seen on <a href="/articles/hysterosalpingogram">HSG</a> as multiple irregular linear filling defects (may give a lacunar pattern), with inability to appropriately distend the endometrial cavity <sup>2</sup>. In severe cases there can even be complete non-filling of the uterine cavity.</p><h5>Pelvic ultrasound</h5><p>May be seen as hypoechoic bands traversing through the endometrial cavity. <a href="/articles/sonohysterography">Sonohysterography</a> may be useful for evaluation.</p><h5>Pelvic MRI</h5><p>The adhesions are usually low signal on T2.</p><h4>Treatment and prognosis</h4><p>The goal of treatment 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 <sup>3</sup>. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.</p><h4>History and etymology</h4><p>The condition was Initially described by <strong>Joseph Asherman </strong>in 1948 <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>On a <strong>hysterosalpingogram</strong> consider:</p><ul><li>- +<p><strong>Asherman syndrome</strong>,<strong> </strong>also known as <strong>uterine synechiae</strong>, is a condition characterised by the formation of intrauterine adhesions, which are usually sequela from injury to the <a href="/articles/endometrium">endometrium</a>, and is often associated with infertility.</p><h4>Epidemiology</h4><p>There is a tendency for the condition to develop soon after pregnancy (usually within four months <sup>9</sup>). The incidence is thought to be increasing probably as a result of increased use of intrauterine interventions.</p><h4>Clinical presentation</h4><p>Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain <sup>1</sup>.</p><h4>Pathology</h4><p>Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring<sup> 1</sup>. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. <a href="/articles/tuberculous-pelvic-inflammatory-disease">genital tuberculosis</a>).</p><p>The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.</p><h4>Radiographic features</h4><h5>Hysterosalpingogram</h5><p>Intrauterine adhesions are typically seen on <a href="/articles/hysterosalpingogram">HSG</a> as multiple irregular linear filling defects (may give a lacunar pattern), with the inability to appropriately distend the endometrial cavity <sup>2</sup>. In severe cases, there can even be complete non-filling of the uterine cavity.</p><h5> Ultrasound</h5><p>May be seen as hypoechoic bands traversing through the endometrial cavity. <a href="/articles/sonohysterography">Sonohysterography</a> may be useful for evaluation.</p><h5>MRI</h5><p>The adhesions are usually low signal on T2.</p><h4>Treatment and prognosis</h4><p>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 <sup>3</sup>. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.</p><h4>History and etymology</h4><p>The condition was Initially described by <strong>Joseph Asherman </strong>in 1948 <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>On a hysterosalpingogram consider:</p><ul><li>
-<a href="/articles/amniotic-sheets">amniotic sheets</a>: uterine synechiae occuring in pregnancy</li>- +<a href="/articles/amniotic-sheets">amniotic sheets</a>: uterine synechiae occurring in pregnancy</li>
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