Asherman’s syndrome after removal of placenta remnants: a serious clinical problem

Abstract

Intrauterine adhesions (IUA) or Asherman’s syndrome is thought to develop after trauma to the uterine cavity by destruction of the basal layer of the endometrium. IUA can result in menstrual disorders, infertility, and complication during pregnancy and delivery. IUA formation is multifactorial, with pregnancy being an important etiologic factor. Performing a postpartum exploration/evacuation or curettage can lead to adhesion formation. We present three patients who presented with a menstrual disorder after postpartum surgical intervention on suspicion of placental remnants. Hysteroscopic evaluation revealed severe intrauterine adhesions with complete obliteration of the uterine cavity. Repeated and extensive hysteroscopic adhesiolysis is performed to acquire a cavity with a normal appearance. Besides the puerperal uterus, the time of surgical performance is crucial in the risk for adhesion formation. Performing a late surgical intervention, as from 24–48 h after delivery, leads to an increased risk for adhesion formation. Prevention of IUA can be established by an accurate indication for late postpartum surgical interventions. When performing a late surgical intervention, hysteroscopic surgery is preferable. Firstly, hysteroscopy allows the possibility for identification of placental remnants, and secondly, the possibility for selective removal, thus avoiding unnecessary trauma to the endometrium compared to blindly curettage. Caution is advised when performing a late puerperal surgical intervention. An accurate indication is essential, and when needed, hysteroscopic surgery is preferable, minimizing trauma to the endometrium.