Abstract

PIP: Asherman's syndrome is described in today's context. Meaningful literature as it relates to the description and management of this entity is reviewed, and the forms of treatment used at the Hospital of the University of Pennsylvania or at the Philadelphia General Hospital are presented. Asherman's syndrome describes a variable amount of destruction of the endometrial cavity, diminished menstrual flow, infertility, and repeated pregnancy loss. The incidence of Asherman's syndrome was believed to be low, but Eriksen reported a 20-25% incidence of intrauterine adhesions of some degree in all patients treated with a dilatation and curettage within 2 months after delivery. The number of cases of Asherman's syndrome reported by other authors is unusually high, and a table of inferred incidence and therapeutic approaches is included. The main symptoms of Asherman's syndrome are infertility, secondary amenorrhea, cyclic painful hypoamenorrhea, menstrual irregularities, and habitual abortion. 11 patients with Asherman's syndrome presenting as intrauterine distortion and diminished menstrual flow were treated at the Department of Obstetics and Gynecology of the University of Pennsylvania, at the Hospital of the University of Pennsylvania, or at the Philadelphia General Hospital during the interval between July 19678 and June 1972. The patients ranged in age from 22-37. 6 were referred for infertility, and 5 were diagnosed during the course of delivery of primary care. The therapeutic regimes which were used for most of these patients are listed in a table. The approach consisted of careful sounding of the uterine cavity, followed by dilatation and curettage with histologic examination. A pediatric Foley catheter was inserted into the uterine cavity and the bag was filled to a 3-ml volume. Conjugated estrogens were given at dosages of 5.0-7.5 mg daily in divided doses. The estrogen dose was increased in instances of breakthrough bleeding. Broad-spectrum antibiotics were initiated preoperatively in most cases. The Foley catheter was removed after 5-7 days. Antibiotics were continued for a week to 10 days, and the estrogens were continued for 21 days. It was possible to reestablish normal menstrual patterns in 6 of the 7 women with severe disease. Pregnancies were established in 4 of these patients. There were 2 spontaneous abortions. In patients with moderate disease, a return to normal menstrual pattern occurred in all instances, but only 2 became pregnant. 1 pregnancy went to term, and the other is still in progress.