"> DOI:10.18643/gieu.2016.166
"> DOI:10.18643/gieu.2016.166
"/> Asherman’s syndrome after an uncomplicated cesarian section
<- Home <- Arhive <- Vol. 12, Issue 4, December 2016


Asherman’s syndrome after an uncomplicated cesarian section

C. Mehedintu, O. Ionescu, A. Rotaru, M. Antonovici, M. Plotogea, C. Berceanu, S. Vladareanu, E. Bratila

Abstract: Intrauterine adhesions (IUAs) and their worst form, the Asherman’s syndrome, are the result of endometrium basal layer damage, leading to partial or complete obliteration of the uterine cavity by fibrous bridges between the uterine walls. We present the case of a 30 years old woman, gravida 1, para 1 that suffers from secondary amenorrhea and infertility resulted from IUAs formation after an uncomplicated cesarean section, which she underwent 2 years before. Although she never breastfed, she did not start menstruating again after the cesarean section. Clinical and hormonal examinations were in normal ranges and the transvaginal ultrasound revealed an eccentric echogenic endometrium. Hysterosalpingography showed multiple intrauterine filling defects and bilateral tubal occlusion. The operative hysteroscopy revealed multiple intrauterine adhesions originating from the former caesarean incision site and extending to the entire uterine cavity. In spite of hysteroscopic adhesiolysis, intrauterine device insertion and hormonal therapy being provided, the patient never regained fertility. Patients with Asherman’s syndrome usually present infertility, recurrent pregnancy loss, amenorrhea or hypomenorrhea. The main cause is known to be the endometrium damage following pregnancy-related curettage. Less common etiologic factors are represented by caesarean section, hysteroscopic procedures, myomectomy and histerotomy. Around 2-2.8% of the patients develop IUAs after cesarian section, more likely as a result of chorioamnionitis, postpartum endometritis, postpartum curettage or uterine compression sutures for postpartum hemorrhage. Severe intrauterine adhesions are a challenging gynecological pathology. The particularity of the case is due to an unusual extensive endometrium damage following uncomplicated caesarian section.

Keywords: intrauterine adhesions, Asherman’s syndrome, infertility.

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