Asherman syndrome-one century later

Abstract

Objective: To provide an update on the current knowledge of Asherman syndrome. Design: Literature review. Setting: The worldwide reports of this disease. Patient(s): Patients with Asherman syndrome who presented with amenorrhea or hypomenorrhea, infertility, or recurrent pregnancy loss. Intervention(s): Hysteroscopy and hysteroscopic surgery have been the gold standard of diagnosis and treatment respectively for this condition. Main Outcome Measure(s): The etiology, pathology, symptomatology, diagnosis, treatment, and reproductive outcomes were analyzed. Result(s): This syndrome occurs mainly as a result of trauma to the gravid uterine cavity, which leads to the formation of intrauterine and/or intracervical adhesions. Despite the advances in hysteroscopic surgery, the treatment of moderate to severe Asherman syndrome still presents a challenge. Furthermore, pregnancy after treatment remains high risk with complications including spontaneous abortion, preterm delivery, intrauterine growth restriction, placenta accrete or praevia, or even uterine rupture. Conclusion(s): The management of moderate to severe disease still poses a challenge, and the prognosis of severe disease remains poor. Close antenatal surveillance and monitoring are necessary for women who conceive after treatment. © 2008 American Society for Reproductive Medicine.