Intrauterine adhesions

Abstract

Anticipation and suspicion are critical aspects to any discussion of intrauterine adhesions. Curettage between the second and fourth week postpartum is more likely to cause adhesions than is any other endometrial trauma. Infertility, recurrent abortion, or menstrual aberrations after any uterine trauma should cause the physician to suspect the presence of intrauterine adhesions. Hysterosalpingography and hysteroscopy are the ideal methods to make the diagnosis of IUA, and the latter is the safest, least traumatic, and most precise method of treating adhesions. The addition of an intrauterine splint and high-dose estrogen therapy completes the therapeutic approach. Before attempting conception the cavity should be inspected to verify its normality.

PIP: This paper reviews what has been reported about intrauterine adhesions (IUAs) from their earliest description. Endometrial trauma, most often caused by curettage associated with pregnancy, must occur before IUAs will develop. Postpartum curettage will most likely cause IUAs if it is performed between the second and fourth week postpartum. The symptoms of IUAs are amenorrhea/hypomenorrhea, infertility, recurrent abortion, and/or adherent placenta. The menstrual pattern is usually predictive of the extent of intrauterine scarring, with amenorrhea being associated with the most extensive damage. Diagnosis can be confirmed and classified by hysteroscopy. The safest, least traumatic, and most precise method of operative treatment involves adhesiolysis, using hysteroscopy with the use of a postoperative intrauterine splint and administration of postoperative high-dose estrogen therapy. Before conception is allowed, the uterus should be examined to verify its normality. This treatment results in a pregnancy rate of 60-75%, regardless of the pretreatment extent of disease in an otherwise normal uterus. Preconception examination and verification of normality insures against the occurrence of an adherent placenta during subsequent pregnancy.