The management of intrauterine synechiae.
OBJECTIVE
Intrauterine adhesions are a rare but significant cause of menstrual disturbance and infertility. Most cases are caused by uterine instrumentation. It is important for clinicians to understand the cause, diagnostic tools and rationale behind treatment.


RESULTS
Hysteroscopy is the gold standard for diagnosis and treatment of intrauterine adhesions. A combination of blunt and sharp dissection or electrosurgery is used by most units. Antibiotics and postoperative administration of estrogen +/- progestogen is important in prevention of recurrence. The use of intrauterine contraceptive devices following synechiolysis is supported by some groups. Restoration of menstruation is highly successful (more than 90%), and pregnancy rates around 50-60% with live birth rates around 40-50% can be achieved.


CONCLUSIONS
Clinicians should maintain a level of suspicion of intrauterine adhesions and should investigate by hysteroscopy if necessary. Treatment should follow a protocol that incorporates sound hysteroscopic technique with antibiotic prophylaxis and postoperative hormonal therapy. Consideration should be given to the use of an intrauterine contraceptive device or Foley catheter for a short period.
Thomson
Angus J M
AJ
Department of Obstetrics and Gynaecology, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK. angus.thomson@worcsacute.nhs.uk
Abbott
Jason A
JA
Deans
Rebecca
R
Kingston
Ashley
A
Vancaillie
Thierry G
TG
D019072:Antibiotic Prophylaxis; D004598:Electrosurgery; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D011372:Progestins / Q000008:administration & dosage; D055502:Secondary Prevention; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*
D004967:Estrogens; D011372:Progestins