Nature of the disease
The formation of synechiae intrauterinae is based on a disruption of the integrity of the basal layer of the endometrium. As a result of inflammatory or traumatic processes, functional tissue is replaced by connective tissue strands. This leads to partial or complete obliteration of the uterine cavity, creating mechanical obstacles to the normal functioning of the organ.
Diagnostic approach
A standard gynecological examination is insufficient to detect synechiae. Modern management includes:
- Ultrasound examination — primary assessment of cavity contours and condition.
- Hysteroscopy — the "gold standard" allowing visual assessment of the extent of the process and the nature of adhesions.
- Histological examination — necessary to rule out concomitant endometrial pathology.
Clinical consequences
The primary danger of synechiae lies in their impact on a woman's reproductive potential. Adhesions can lead to:
- Menstrual irregularities.
- Infertility due to the inability of the fertilized egg to implant.
- Miscarriage due to restricted uterine cavity volume.
Briefly: answers to topical questions
What specific menstrual irregularities are characteristic of intrauterine synechiae?
Intrauterine synechiae are characterized by scanty menstruation, which can progress to complete cessation of menses.
- Scanty menstruation — can progress to amenorrhea in Asherman syndrome.
- Secondary amenorrhea — occurs with complete obliteration of the uterine cavity.
When the uterine cavity is obliterated in the lower third or in the cervical canal while preserving endometrial function in the upper sections, hematometra may occur.
Which intrauterine interventions most frequently cause traumatic endometrial damage and synechiae formation?
Causes of traumatic endometrial damage and intrauterine synechiae formation include various intrauterine manipulations and surgeries:
- Curettage — frequent and aggressive intrauterine curettage, including diagnostic curettage, as well as curettage after abortion during the wound phase.
- Surgical interventions — myomectomy and metroplasty; sources also indicate cervical electroconization.
- Endometrial ablation.
- Insertion of intrauterine devices (IUDs).
Which infectious agents of specific endometritis most frequently lead to the formation of intrauterine synechiae?
Among the infectious causes of intrauterine synechiae, sources indicate genital tuberculosis.
- Mycobacterium tuberculosis can cause uterine damage with the formation of intrauterine synechiae and obliteration of the cavity.
Synechiae of tuberculous etiology have the worst prognosis regarding the recovery of menstrual and reproductive functions and a high risk of recurrence.
What surgical instruments are used to dissect intrauterine synechiae during hysteroscopy?
Various endoscopic, electrosurgical, and laser instruments are used to dissect intrauterine synechiae during hysteroscopy.
- Hysteroscope sheath — used for mechanical blunt separation of centrally located adhesions.
- Endoscopic scissors and forceps — used for mechanical dissection.
- Needle electrode — recognized as the most convenient electrosurgical instrument for adhesion separation.
- Neodymium YAG laser — used for laser surgery of intrauterine adhesions.
What methods are used to prevent synechiae recurrence in the postoperative period?
Mechanical barrier methods and drug therapy are used to prevent synechiae recurrence in the postoperative period.
- Foley catheter insertion — placed in the uterine cavity for 1 day.
- Intrauterine device (IUD) insertion — a Lippes Loop type contraceptive is used for at least 1 month.
- Anti-adhesion gel — a special gel is used for mechanical prevention of adhesions.
- Hormone therapy — high-dose estrogen-progestogen therapy is prescribed for 3–6 months to restore the endometrium.
Synechiae are "patch-like adhesions" inside the uterus that disrupt normal endometrial function.
Class and exam questions
Why are intrauterine synechiae dangerous?
They can cause infertility, menstrual irregularities, and recurrent miscarriage due to uterine cavity deformation.
Which method is the most accurate for diagnosis?
Hysteroscopy is the most informative method as it allows direct visualization of the uterine cavity and assessment of the severity of adhesions.
Do synechiae always require surgical treatment?
Management is determined individually depending on the patient's complaints, degree of cavity obliteration, and reproductive plans.
What else to study on this topic
- Classification of the severity of intrauterine synechiae.
- Methods for preventing adhesion formation after intrauterine interventions.
- Technique for hysteroscopic adhesiolysis.
- The role of hormone therapy in the postoperative period.
- Differential diagnosis with other intrauterine pathologies.
Master the entire topic in the "Obstetrics and Gynecology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Intrauterine synechiae" and another 973 pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 21 video lessons on the subject
Other topics in the "Gynecology" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.