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.
DOI:10.18643/gieu.2016.166