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Uterine Synechiae

Sarah Ines Ramirez, MD and Bernadatte G. Gilbert, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Uterine synechiae are intrauterine adhesions (IUAs).

  • Symptoms may include menstrual disturbance (amenorrhea, hypomenorrhea, or dysmenorrhea), pelvic pain, recurrent spontaneous aborti...

DIAGNOSIS

HISTORY

  • Infertility

  • Menstrual abnormalities

    • Amenorrhea or hypomenorrhea

    • Menstrual pattern does not correlate with severity of adhesions.

    • Endometriosis

  • Hematometra and/or hematosalpinx

  • Recurrent S...

TREATMENT

GENERAL MEASURES

Counsel on option of expectant management (i.e., observation), which confers (1)[C]: 
  • Spontaneous return of menses in 78% within 7 years

  • Spontaneous pregnancy in 46%

  • Limited dat...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Routine visits at 2 and 6 weeks after surgery

  • Repeat hysteroscopy or second-line hysterosalpingography at 2 to 3 menstrual cycles postsurgery to assess for adhesio...

REFERENCES

1
AAGL Elevating Gynecologic Surgery. AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ES...

ADDITIONAL READING

  • Bosteels J, Weyers S, D’Hooghe TM, et al. Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility. Cochrane Database Syst Rev.  2017;(11):CD...

SEE ALSO

Algorithms: Amenorrhea, Secondary; Infertility; Pelvic Pain 

CODES

ICD10

N85.6 Intrauterine synechiae 

ICD9

621.5 Intrauterine synechiae 

SNOMED

  • 361115000 Intrauterine adhesions (disorder)

  • 48236007 Asherman syndrome (disorder)

CLINICAL PEARLS

  • Typical symptoms: secondary amenorrhea, infertility, recurrent SABs, and/or cyclic pelvic pain

  • Prevention of adhesions is key: Minimize intrauterine operative interventions while women ...

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