title: Comprehensive management of severe Asherman syndrome and amenorrhea.
abstract: OBJECTIVE
  To describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary care teaching hospital.
  
  
  METHODS
  Twelve women with severe Asherman syndrome and amenorrhea.
  
  
  METHODS
  Preoperative administration of prolonged preoperative and postoperative oral E(2) to enhance endometrial proliferation, intraoperative abdominal ultrasound-directed hysteroscopic lysis of uterine synechia to ensure that the dissection is performed in the proper tissue plane, placement of a triangular uterine balloon catheter during surgery, and postoperative removal with placement of a copper intrauterine device (IUD) to maintain separation of the cavity and mechanically lyse newly formed adhesions during removal.
  
  
  METHODS
  Resumption of menses, pregnancy, and delivery.
  
  
  RESULTS
  All women resumed menses, although 5 of 12 had a preoperative maximal endometrial thickness of 4 mm or less, with follow-up ranging from 6 months to 10 years. Six of nine women less than age 39 years (67%) became pregnant, and four of six achieved a term or near-term delivery.
  
  
  CONCLUSIONS
  Comprehensive management provides the best possible outcomes in poor-prognosis women with severe Asherman syndrome.
authors.affiliation: Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina 28204, USA.
authors.forename: Erinn M
authors.initials: EM
authors.lastname: Myers
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Hurst
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D006175:Gynatresia / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D007434:Intrauterine Devices; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D011256:Pregnancy Outcome; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D004958:Estradiol