Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion

Abstract

This prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of intrauterine adhesions. In 50 women, undergoing either a secondary removal of placental remnants more than 24 h after delivery, or a repeat curettage for incomplete abortions, ambulatory hysteroscopy was performed 3 months after the intervention. Intrauterine adhesions were found in 20 of the women (40%): five patients had Asherman's syndrome grade I, six had grade II, six had grade III and three had grade IV. In women with menstrual disorders a statistically significant 12-fold increased risk for Asherman's syndrome grade II-IV was found. Previous abortion as well as infection during surgery were associated with a mildly but non-significant increased risk. Based on our findings, hysteroscopy is recommended only in those patients who develop menstrual disorders, either after secondary intervention for placental remnants after delivery or after a repeat curettage.

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

“…The interval after pregnancy at which trauma to the endometrium occurs is the most important factor in the risk of IUA formation [9]. In women undergoing secondary procedures to remove placental remnants after delivery or repeat curettage, IUAs are found in 40 % [10]. The results of a recent systematic review of IUA after miscarriage are in line with previous findings [11].…”

Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

“…The fibrotic synechiae distort the entire uterine cavity and stromal calcifications and ossification are seen. The risk of these adhesions is particularly greater when instrumentation is performed during the second and fourth post-partum weeks affecting 21.5-40 % women [3,[10][11][12] and is far less pronounced if performed within 48-h post-partum probably due to endogenous estrogen levels. After cesarean section the risk of these adhesions being formed is 2 % and post-laparotomy or myomectomy it is 1.3 % [3].…”

Hysteroscopic resection of retained placental tissue: a feasibility study

“…Curettage is very effective but associated with morbidity. Perforation is seen in approximately 3% of women with postpartum curettage [3,6]; severe Asherman's syndrome is seen in 0.5-30% after secondary curettage for retained placental tissue [7,12]. Grade II-IV adhesions are associated with infertility, menstrual disturbances, and placenta accretion when pregnancy occurs.…”