Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman's syndrome: A case report

Abstract

Background: Asherman's syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix, resulting in inability to carry a pregnancy to term, placental malformation, or infertility. We present the case of a 40-year-old woman diagnosed with Asherman's syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation, intrauterine device insertion, and Kaufmann therapy.

Case summary: A 40-year-old woman (Gravida 3, Para 0) arrived at our hospital for specialist care to carry her pregnancy to term. She had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease, followed by chemotherapy. She subsequently became pregnant twice, but both pregnancies resulted in spontaneous miscarriages during the first trimester. Her menstrual periods were very light and of short duration. Hysteroscopic adhesiolysis with concurrent laparoscopy was performed, and Asherman's syndrome was diagnosed. The uterine adhesions covered the area from the internal cervical os to the uterine fundus. Postoperative Kaufmann therapy was administered, and endometrial regeneration was confirmed using hysteroscopy. She became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of gestation. The postpartum course was uneventful, and she was discharged on postoperative day 7.

Conclusion: Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery, without complications.

Keywords: Case report; Hysteroscopic surgery; Intrauterine devices; Laparoscopy; Live birth; Pregnancy.

Figure 1

Intraoperative findings. A: The hysteroscope light source was kept visible during laparoscopic observation; B: Blunt dissection of adhesion tissue was performed using a monopolar electric scalpel.

Figure 2

Postoperative course.

Figure 3

Postoperative findings. A: Hysteroscopy shows no intrauterine adhesions; endometrial regeneration is evident; B: Hysterosalpingography demonstrates contrast medium reaching the fimbriae of both fallopian tubes from the uterine cavity and leaking into the abdominal cavity.