From repair to risk: maternal-fetal outcomes after hysteroscopic treatment of Asherman syndrome.

"The threat of Asherman syndrome": a propensity score-matched study of fetal-maternal outcomes.

Pregnancy-related intrauterine adhesion treatment: new insights

Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. N/A.

Objective: To assess achievement of hysteroscopic treatment for Asherman’s Syndrome(AS), also called ‘intrauterine adhesions(IUAs) or Intrauterine synechiae’. Method: Retrospectively,27 patients with AS were enrolled in our study at ankara liv hospital between 2017-2019 . These patients were evaluated with hysteroscopically then they had adhesiolysis at the same session. Monopolar knife was used for adesiolysis and the operation was gone on until adequate cavity enlargement was achieved. Intrauterine device (IUD) was placed in the new occurred cavity and combined hormonal therapy(high dose estrogen and progesteron) was given for two months. American Fertility Society classification was used for scoring of IUAs. After IUD was taken out, they were called and their menstrual pattern and fertility status were learned. If their symptoms were recurred they were hysteroscopically evaluated again. Results: 27 patients were hysteroscopically diagnosed as AS . 15of them had reproductive problems and other 12 patients had only menstrual abnormality. 13 patients had pregnancy related curettage, 4 patients had dilatation and curratage(D&C) for their menstrual problems. After hysteroscopic treatment, 6 of 12 patients with only menstrual abnormality had normal menstual pattern, 2 of them did not have normal period but a little bit better(from amenorrhoea to hypomenorrhoea). 8 of 15 infertile patients had positive pregnancy test(live born:6, spontaneous abortion:2). And also all these pregnant womens were seconder infertile patients. Conclusions: Hysteroscopy is the most useful technique for diagnosis and treatment for Asherman’s Syndrome. And also, hysteroscopic procedure has positive effect on pregnancy rate and menstrual regularity

Uterus transplantation: animal research and human possibilities

In a retrospective case report series, we evaluated the efficacy of hysteroscopic adhesiolysis in patients with severe Asherman's syndrome. In 31 patients with permanent severe adhesions, hysteroscopic treatment was performed. In all patients, uterine cavity with at least one free ostial area was restored after one (n = 16), two (n = 7), three (n = 7), and four (n = 1) surgical procedures. All previously amenorrhoeic patients (n = 16) had resumption of menses. Twenty-eight patients were followed-up with a mean time of 31 months (range 2-84). Fifteen pregnancies were obtained in 12 patients and the outcomes were the following: two first trimester missed abortions, three second trimester fetal losses, one second trimester termination of pregnancy for multiple fetal abnormalities and nine live births in nine different patients. Pregnancy rate after treatment was 12/28 (42.8%) and live birth rate was 9/28 (32.1%). In patients </=35 years, 10 out of 16 conceived (62.5%) versus two out of 12 (16.6%) in patients >35 years (P = 0. 01). Three patients were lost to follow-up and their results omitted. In nine patients with live births, one Caesarean hysterectomy for placenta accreta and one hypogastric arteries ligation for severe haemorrhage and placenta accreta were performed. Hysteroscopic treatment of severe Asherman's syndrome appeared to be effective for the reconstruction of a functional uterine cavity with a 42.8% pregnancy rate. However, these pregnancies were at risk for haemorrhage with abnormal placentation.

Incidence and Clinical Implications of Placenta Accreta Spectrum (PAS) after Hysteroscopic Treatment for Asherman's Syndrome

We review the current evidence about the treatment modalities of intrauterine adhesions (IUA) or Asherman’s Syndrome (AS). Systematic approach, audit and well-structured research is mandatory in order to establish the best treatment for the individual needs of patients. The clinical practice changed significantly over the last 20 years with technological advances in hysteroscopy and imaging techniques. Hysteroscopic treatment seems effective and safe. IUA or AS is a rather uncommon finding in general gynaecological practice. The referral to a tertiary centre will help to centralise the most difficult cases and create the opportunity to study more in detail the efficacy of each treatment modality and to compare the different treatment techniques.

Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes

Incidence and Clinical Implications of Placenta Accreta Spectrum after Treatment for Asherman Syndrome

Preoperative sonographic measurement of endometrial pattern predicts outcome of surgical repair in patients with severe Asherman’s syndrome

An Argument for Quality Improvement in Asherman Syndrome Counseling

Three cases of a via falsa in patients suffering from primary sterility are reported. In other hospitals a diagnosis Asherman's syndrome was made and the patients were admitted to our endoscopic centre for hysteroscopic treatment. Since the patients had not undergone previous intrauterine interventions the hysteroscopic diagnosis procedures were repeated. In all 3 cases we found a via falsa to the isthmocervical portion. The via falsa to the myometrium was regarded as an obliterated cavity and was thus wrongly diagnosed as Asherman's syndrome. In two cases we found a regular uterine cavity. In the third case we detected a uterine septum in the cavum, which was dissected by hysteroscopy in the same session. The three cases show that with patients suffering from primary sterility a via falsa should also be considered if Asherman's syndrome is suspected before arriving at this prognostically unfavourable diagnosis in respect of further fertility.

Hysteroscopic treatment of Asherman's syndrome

BackgroundAsherman syndrome is one of the endometrial factors that influence a woman’s reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome.MethodA retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul’s Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively.ResultA total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21–39) at the initial presentation, and 32.3 years (range: 22–40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%.ConclusionOur study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.