title: A 10-year Review of the Clinical Presentation and Treatment Outcome of Asherman's Syndrome at a Center with Limited Resources.
abstract: BACKGROUND
  Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA.
  
  
  OBJECTIVE
  This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman's syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997-2006.
  
  
  METHODS
  This is a retrospective study of cases of Asherman's syndrome managed at the UMTH over a 10-year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records' Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi-square and binary logistic regression were used for inferential statistics.
  
  
  RESULTS
  Asherman's syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy-associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley's catheter insertion and estrogen-progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent's related risk factors associated with the development of Asherman's syndrome.
  
  
  CONCLUSIONS
  Asherman's syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman's syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored.
authors.affiliation: Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria.
authors.forename: I U
authors.initials: IU
authors.lastname: Takai
authors.affiliation: Department of Obstetrics and Gynecology, State Specialist Hospital, Maiduguri, Borno State, Nigeria.
authors.forename: A S
authors.initials: AS
authors.lastname: Kwayabura
authors.affiliation: Department of Obstetrics and Gynecology, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria.
authors.forename: E A
authors.initials: EA
authors.lastname: Ugwa
authors.affiliation: Department of Obstetrics and Gyecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.
authors.forename: A
authors.initials: A
authors.lastname: Idrissa
authors.affiliation: Department of Obstetrics and Gyecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.
authors.forename: J Y
authors.initials: JY
authors.lastname: Obed
authors.affiliation: Department of Obstetrics and Gyecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria.
authors.forename: M
authors.initials: M
authors.lastname: Bukar
keywords: Asherman's syndrome; Clinical presentation; Maiduguri; Treatment outcome