Intrauterine sinuxes - what is it?

Intrauterine synechia or, as they are called, "Asherman's syndrome" - partial or complete infection of the uterine cavity. It's not the diseases of the labia, it's much more serious. In the male part of the population there is a similar problem - the sinhia of the foreskin.

There are traumatic, infectious and neuro-visceral theories of the origin of this problem. The main factor is a trauma of the basal layer of the endometrium that occurs after abortion or childbirth and which has a mechanical character. Infection is already a secondary factor. The most traumatic period is the period of the first four weeks after the abortion or childbirth.

Quite often intrauterine synechiae appear in patients who have a frozen pregnancy. It is they, much more often than others, after scraping the uterine cavity develops the problem of synechia. This is due to the fact that the remainder of the placental tissue can cause activation of the formation of collagen and fibroblasts even before the full endometrium is completely regenerated. Intrauterine synechiae appear in 5-40 percent of patients who have repeated miscarriages.

In addition, this problem can arise after the surgical interventions in the uterus: metroplasty, myomectomy or scraping of the mucosa for diagnostic purposes. Also, an intrauterine contraceptive may provoke intrauterine synechia.

Symptoms

Depending on how much the uterine cavity is infected, hypomenstrual syndrome, amenorrhea and its consequence - infertility, miscarriage of pregnancy - can manifest . In the case when only the lower part of the uterus is infected, and the endometrium normally functions, a hematometer can develop. The strong infection of the uterus and the lack of a normally functioning endometrium can lead to difficulties with the implantation of the fetal egg. Even slightly pronounced intrauterine synechia is the cause of inefficiency in fertilization.

One third of women suffering from intrauterine synechia will receive spontaneous miscarriages, another number - premature births, and one third - placental pathology (previa or tight attachment). This means that pregnancy in patients with synechia should be considered as a considerable risk, complications may occur during pregnancy, childbirth and in the postpartum period.

Treatment

To date, the only way to treat this problem can be called dissection of synechia under visual direct control by a hysteroscope. In this case, there should be no trauma to the endometrium in order to restore the normal menstrual cycle and fertility. The operation, its effectiveness and the expected results can depend only on the type of synechia and the degree of occlusion of the uterine cavity.

The central synechia can be divided by a blunt hysteroscope body. In addition, use endoscopic forceps and scissors, a hysteroresectoscope with an electrode.

Small synechia is quite easily destroyed by forceps, scissors or hysteroscope hull. The synechia with a greater density is dissected gradually with scissors until the uterine cavity is restored to normal form.

In order to get rid of dense fibrous synechia, most often use a hysteroresectoscope with an electrode or a laser conductor. To prevent perforation of the uterus (which is very possible), it is best to perform the operation under ultrasound control with unexpressed uterine occlusion and under laparoscopic control, when the occlusion is significantly pronounced.

After dissection of intrauterine synechia, pregnant girls are at risk. In addition to the frequent inability to bear a child, there is still a threat of postpartum hemorrhage.