Success of Serial Office Resection in Severe Asherman's Syndrome

Abstract

<h3>Study Objective</h3> Demonstrate the feasibility and effectiveness of serial office hysteroscopic lysis of adhesions for a severe case of Asherman's Syndrome. <h3>Design</h3> Video. <h3>Setting</h3> Outpatient gynecologic clinic. <h3>Patients or Participants</h3> 38-year-old G1P1001 diagnosed with Asherman's Syndrome after a vaginal delivery followed by a postpartum hemorrhage requiring a D&C and Bakri balloon placement. She is amenorrheic and desires future fertility. <h3>Interventions</h3> The patient had three office visits for lysis of adhesions with a rigid hysteroscope and semi-rigid scissors. The first office hysteroscopy had a duration of 21 minutes, the second office hysteroscopy had a duration of 4 minutes, and on the third visit, no recurrent intrauterine adhesions were seen and no further resection was necessary. She was pre-treated with ibuprofen prior to the procedure and tolerated the intervention well. The patient took 1mg estradiol PO BID during the treatment course. <h3>Measurements and Main Results</h3> The patient's intrauterine adhesions were completely resolved by the end of the hysteroscopy series. She tolerated all the office procedures well with minimal medication for pain control. We believe our vaginoscopy technique for office hysteroscopy procedures leads to minimal pain. Additionally, we demonstrate the necessary components and benefits of a sustainable office hysteroscopy practice. <h3>Conclusion</h3> Serial hysteroscopic resection in the office for severe Asherman's Syndrome is safe, effective, and well-tolerated by patients.