Septums and Synechiae: Approaches to Surgical Correction

Abstract

If the Müllerian ducts fail to fuse, or, if the wall which is the result of fusion is not adequately resorbed, the result is a spectrum of uterine abnormalities called Müllerian fusion and absorption defects. The impact of these abnormalities on fertility is a subject for debate, but at least a subset seems to have a negative impact on reproductive performance manifesting in recurrent abortion and/or premature labor. Previous surgical interventions required laparotomy, but, with careful application of imaging techniques, a group of patients can be identified with a uterine septum amenable to removal under hysteroscopic direction with little morbidity. Intrauterine adhesions or synechiae are usually secondary to curettage in the context of missed abortion or pregnancy-related hemorrhage. These lesions cover a spectrum that ranges from minor and insignificant to severe cohesive adhesions that affect menstrual function and fertility. Surgical repair of the endometrial cavity affected with such adhesions presents a challenge to the hysteroscopic surgeon. Appropriate management is controversial but may include second loop hysteroscopy and the use of postoperative adjuvants such as systemic estrogens and intrauterine devices or systems designed to impede the development of adhesions.

Hysteroscopic adhesiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes

“…Roy et al [12] reported that the use of concurrent laparoscopy is helpful for determining the boundaries of the adhesiolysis, but they encountered 2 cases of uterine perforation during the procedure. Hysteroscopic adhesiolysis under laparoscopic or fluoroscopic guidance is not necessary to reduce the risk of uterine perforation [14]. There were no cases of uterine perforation in our series.…”

Uterus didelphys with an obstructed unilateral vagina and ipsilateral renal agenesis: A rare cause of dysmenorrhoea

“…A history of pelvic pain following the menarche, dysmenorrhoea and an increase in abdominal volume are complaints that are suggestive of uterine anomalies. Primary amenorrhoea and changes to menstrual flows may also be present (9). Usually, on examination, a unilateral pelvic mass is detected, with the right side affected nearly twice as frequently as the left side (10).…”

Congenital Uterine Anomalies

“…Endometriosis is a common fi nding in women with obstructive and nonobstructive Müllerian anomalies and is a known etiology of infertility [ 29 , 37 ]. Abnormal bleeding can also occur with uterine anomalies and has been associated with septate uteri [ 29 ]. Furthermore, vaginal anomalies may occur in conjunction with uterine anomalies, and abnormal bleeding may be due to a partial or microperforate vaginal obstruction or a longitudinal vaginal septum.…”