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Severe intrauterine adhesions
Title: Hysteroscopic treatment of sever Asherman's syndrome and
subsequent fertility
Author: S. Capella-Allouc, et al.
Address: Clamart, France
Source: Human Reproduction 14: 1230-1233 (May) 1999
Summary: The purpose of this study was to determine the safety and
effectiveness of hysteroscopic adhesiolysis in the treatment of 31 patients with
severe Asherman's syndrome by observing the reestablishment of the uterine
cavity, postoperative resumption of menses, pregnancy rate and outcome in a
retrospective case report series. Pregnancy rate after treatment was 12/28 and
live birth rate after treatment was 9/28. In patients <35, 10/16 conceived,
versus 2/12 in patients >35. Hysteroscopic treatment of severe Asherman's
syndrome appeared to be effective for the reconstruction of a functional uterine
cavity. All patients achieved a normal uterine cavity and all previously
amenorrhoeic patients (n=16) had resumption of normal menses. The overall
pregnancy rate after treatment was 42.8%, with a live birth rate of 32.1%.
However, these pregnancies were at risk for hemorrhage with abnormal placentation
and subsequent pregnancies should be managed appropriately in a tertiary care
reproductive center.
Comment: Severe cases of intrauterine adhesions are a dreadful survival
challenge partly because the uterus is so necessary for fertility. The above seems to
support a relatively low success rate after surgery. I believe that many studies
that report high success rates are dealing with only minimal and mild cases. The
above authors also report a very poor obstetric outcome with a caesarean
hysterectomy as one complication.
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