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18. Asherman Syndrome
Hi guys I am back with another video , in this video we will discuss about the Asherman syndrome . What is Asherman syndrome? It is the condition in which the uterine lining has been destroyed to such an extent that the menstruation has stopped , also called secondary amenorrhea due to endometrial destruction. The absence of menses is due to unknown Etiology and due to endometrial destruction. Now let us come to know about the Etiology : the first Etiology is Endometrial tuberculosis and the second one is overzealous curettage , Endometrial tuberculosis causes tubercular endometritis which heals by the formation of scars, it causes Asherman syndrome.
Curettage is done for MTP that is medical Termination of pregnancy , abnormal uterine bleeding and secondary PPH.
Now what is the process of using a curettage ?
Step by step removal of posterior wall, anterior wall , left wall , right wall , fundus , isthmus.
Scraping of uterine muscles beyond the endometrial lining into the basal laminate causes grating sounds . The precautions we can take while during curettage in order to prevent the Asherman syndrome are : if we can listen to the grating sounds and bubbling of blood , then we should stop the curettage right at that moment . The maximum chances of occurrence of Asherman syndrome is when the curettage is done for secondary PPH.
So the instrument which is used for doing curettage is Sims curette which is used for doing Evacuation , curettage , biopsy and suction .
So the diagnosis can be done using ultra sound, hysteroscopy , hysterosalpingography.
Now let us come to know about the treatment :
The first one is hysteroscopic adhesion lysis
Which is done with scissors , electronic instruments like bipolar cautery and Saline or unipolar cautery and glycine are used.
Agglutinated thick scars are removed.
Allows basal endometrium to grow .
Due to small area of uterine cavity , it collapses and exudates come out which causes formations of adhesions again.
. We can also keep an IUCD to prevent adhesion formation like copper T.
For the regrowth of endometrium, follow with high dose of estrogen and progesterone for the re modelling of the endometrium.
So this is all about this topic , thank you !
