Comprehensive management of severe Asherman syndrome and amenorrhea

Capsule:
A comprehensive approach to women with severe Asherman syndrome and amenorrhea is outlined including standardized preoperative, operative, and postoperative care. All women resumed menses, and 50% conceived after treatment.

Authors:
Erinn M. Myers, M.D. and Bradley S. Hurst, M.D
Volume 97, Issue 1 , Pages 160-164, January 2012

Objective:
To describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy.

Design:
Retrospective case series.

Setting:
Tertiary care teaching hospital.

Patient(s):
Twelve women with severe Asherman syndrome and amenorrhea.

Intervention(s):
Preoperative administration of prolonged preoperative and postoperative oral E2 to enhance endometrial proliferation, intraoperative abdominal ultrasound-directed hysteroscopic lysis of uterine synechia to ensure that the dissection is performed in the proper tissue plane, placement of a triangular uterine balloon catheter during surgery, and postoperative removal with placement of a copper intrauterine device (IUD) to maintain separation of the cavity and mechanically lyse newly formed adhesions during removal.

Main Outcome Measure(s):
Resumption of menses, pregnancy, and delivery.

Result(s):
All women resumed menses, although 5 of 12 had a preoperative maximal endometrial thickness of 4 mm or less, with follow-up ranging from 6 months to 10 years. Six of nine women less than age 39 years (67%) became pregnant, and four of six achieved a term or near-term delivery.

Conclusion(s):
Comprehensive management provides the best possible outcomes in poor-prognosis women with severe Asherman syndrome.

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