Intrauterine synechia

Intrauterine synechia: Description, Causes and Risk Factors:Intrauterine synechiaIntrauterine synechia were described as far back as 1984. Since then sporadic accounts have occurred in the literature, and lately the condition has become more prominent, most probably because of the more thorough investigation in the cases of infertility. Trauma to tissues, either of mechanical or of inflammatory nature, is likely to cause scarring and agglutination of surfaces. This might be in the form of a very fine fibrinous adhesion or gross fibrotic tissue formation. Damage to the lining of the female genital tract can causes adhesions, e.g. closure of the tubes as a result of salpingitis; conglutination of the cervix after electrical coagulation; and stenosis of the vagina with formation of severe keloid and cartilaginous scarring is seen.Post-traumatic Intrauterine synechia lesions were first described by Fritsch' in 1894. The patient developed amenorrhoea after postpartum curettage, and at hysterectomy the uterine cavity was found to be occluded.Symptoms:The symptomatology varies with the degree of trauma.In mild cases there may be no symptoms at all, and thecondition is diagnosed accidentally while investigating infertility or recurrent abortion.In the severe cases amenorrhea(absence or suppression of normal menstrual flow) is common. This isunderstandable as the uterine cavity may be completelyoccluded as in one case, or the remaining endometriumbecomes inactive.Diagnosis:The diagnosis may be suggested by the history, e.g.hypomenorrheaoroligomenorrhea. History of recurrent curettage or curettage following an advanced pregnancy, especially after a secondary postpartum haemorrhage, may be predisposing factors.Stenosis or conglutination of the cervical canal can bedetected by instrumental exploration.The confirmation is by hysterogram. The condition issometimes diagnosed on routine hysterographic examination for sterility or habitual abortion. The hysterogramshows filling defects and deformation of the outline of theuterine cavity.Submucous myoma or polyps may produce a similarpicture. Endometritis may also complicate the picture.Bicornuate uterus or subseptate uterus may be simulated, but one usually finds that the defect spreads down asymmetrically and is bizarre as compared with the averageseptum found in these conditions. Air or mucus in theuterine cavity can simulate a filling defect but then this isnot usually a constant shadow as in the abnormality causedby the adhesion.Treatment:Two forms of treatment can be adopted. The first, or more conservative form of treatment, is that of dilating the stenosed canal from below. If the canal is not affected it should still be gently dilated and the uterine cavity is gradually dilated by using sweeping movements of a dilator.The second method of treatment which is advocated is by laparotomy. A vertical incision is made in the anterior aspect of the uterus extending to and into the internal os (internal orifice of the uterus). The synechia are excised. The fallopian tube is excised at the cornu and then reimplanted into the uterine wall. The degree of success after such an operation is not very great.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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