The universal incidence of synechia uteri (Asherman's syndrome) is steadily increasing. The main offender in the etiology of this disorder is trauma to a pregnant uterus, especially after curettage in puerperium or after missed abortion, whereas the role of infection in traumatic intrauterine adhesions should be viewed with caution. Genital tuberculosis is one of the main etiological factors of this condition. The syndrome is expressed by infertility (43%) and menstrual disorders (62%). Pregnancy, when achieved, may be complicated by premature labor, placenta previa and placenta accreta. The diagnosis is made by hystersalpingography, and mainly by hysteroscopy. Preferred treatment is lysis of adhesions by hysteroscopy, followed by immediate insertion of an intrauterine device, combined with a course of estrogens. The success of treatment regarding term deliveries and rate of abortions depends on the severity of the adhesions. We carried out studies regarding regeneration of the endometrium, and intended to induce intrauterine adhesions as a method of treatment in cases of severe uterine bleeding and as a method of contraception.

The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes.Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period.Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (< 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (< 0.05).Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.Copyright: © 2023 Gynecology and Minimally Invasive Therapy.

To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal.

Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy. Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods. Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature search with a wide range of search terms.

Intrauterine adhesions (IUA) following any less invasive uterine procedure like curettage or due to genital tuberculosis can lead to partial or complete dysfunction of the endometrium due to adhesions and uterine scarring with impairment of fertility and menstruation and also recurrent pregnancy loss. Therefore, hysteroscopic adhesiolysis was beneficial in this case in restoring fertility, and hence, the introduction of hysteroscopy has definitely improved the fertility outcome and positive reproductive outcome. This is a case report of a 28-year-old infertile woman with IUA leading to bilateral corneal block following dilatation and curettage who conceived after hysteroscopic adhesiolysis.Copyright: © 2019 Gynecology and Minimally Invasive Therapy.

Intrauterine adhesions, also known as Asherman's syndrome, can have an impact on both reproductive outcomes and gynaecologic symptoms. Understanding the cause of intrauterine adhesions and the common clinical presentation will increase awareness of the condition and guide the patient to appropriate therapy. Surgical management offers favourable fertility outcomes and is often successful in restoring menstruation.

To evaluate the diagnostic accuracy of sonohysterography (SHG) in uterine cavity diseases in infertile patients, comparing its results with those of hysterosalpingography (HSG) and transvaginal sonography (TVS). Hysteroscopy was the gold standard.Descriptive, prospective study.A tertiary university referral center.Sixty-five infertile women 19 to 43 years of age.Patients underwent SHG, conventional TVS, HSG, and hysteroscopy.The results of each examination were compared with those obtained by the gold standard. The following diagnoses were considered separately: polypoid lesions, uterine malformations, intrauterine adhesions, and endometrial hyperplasia (EH). Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals were calculated.Sonohysterography had the same diagnostic accuracy as the gold standard for polypoid lesions and EH, with no equivocal diagnosis. Hysterosalpingography showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for EH. Transvaginal sonography had both sensitivity and PPV of 75% for polypoid lesions and EH. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSG both had a sensitivity of 44.4%. Sonohysterography and HSG had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. Transvaginal sonography showed sensitivity and PPV of 0% for this diagnosis.Sonohysterography was in general the most accurate test. Its diagnostic accuracy was markedly superior for polypoid lesions and EH, with total agreement with the gold standard. In diagnosis of intrauterine adhesions, SHG had limited accuracy, similar to that obtained by HSG, with a high false-positive diagnosis rate.

To prospectively compare the diagnostic ability of both HSG and diagnostic hysteroscopy in recurrent aborters, an HSG followed by a diagnostic hysteroscopy was performed in 106 patients during an investigation into recurrent abortions. The uterine cavity findings on HSG and at hysteroscopy were compared. Among the 60 abnormal HSG patients, intrauterine pathology was demonstrated in 37 (34.9%). Among the 46 normal HSG patients, a normal uterine cavity was found in 33 (31.3%). The sensitivity of the HSG in revealing intrauterine abnormalities was therefore 79% and its specificity 60%. In 23 pathologic HSG, no abnormalities were seen by hysteroscopy. In 13 cases, hysteroscopy demonstrated mild intrauterine findings overlooked by HSG. The false-positive rate was 38% and the false-negative rate was 28%. Hysterosalpingography showed a high false-positive rate, especially in the intrauterine adhesions group. In view of the low specificity and high false-positive and false-negative rates, we believe that hysteroscopic evaluation of the uterine cavity is superior to HSG in recurrent abortions.

Sixty-six patients who had the presumptive diagnosis of Asherman's syndrome underwent hysteroscopic evaluation and treatment. In 65 patients, hysteroscopy was performed on an outpatient basis under local anesthesia. In all but five patients, complete lysis of adhesions was accomplished during the initial hysteroscopy. Uterine perforation occurred in two of the 66 patients. The extent of the intrauterine adhesions correlated with the patients' presenting menstrual patterns, but not with prior hysterosalpingography. Of the patients who have completed surgical and hormonal therapy, 98 per cent have normal spontaneous menses. Follow-up examination of the endometrial cavity was normal in 32 of 34 patients. Seven of ten patients who wished to conceive and who had no other infertility factors have done so. The pregnancies have been uncomplicated. Hysteroscopy is the method of choice to diagnose, classify, treat, and follow-up patients with Asherman's syndrome.

In this report of 69 patients, a new type of hysteroscope was used to evaluate the extent and character of intrauterine adhesions, to perform lysis of them, and to monitor the effects of therapy. Additionally, prospective studies with regard to pathogenesis and endometrial regeneration can be achieved in vivo. In 59 patients the procedures were performed in an office setting using a CO2 hysteroscopic technique without the need for local anesthesia or cervical dilatation. Of 30 infertile patients, 38% subsequently had uncomplicated deliveries. The severe forms of this disease still remain very difficult to treat effectively. When the adhesions were severe or the procedure painful, the operation was scheduled under general anesthesia (ten cases). A sequential hysteroscopy with good patient acceptance affords additional opportunity for removing residual adhesions and intrauterine devices, and serves as a basis for ending treatment with steroids.

One hundred eighty-seven patients were evaluated and treated by hysteroscopy over a 10-year period. To assess therapeutic prognosis, these patients were classified according to the extent of uterine cavity occlusion seen on hysterosalpingography and the type of intrauterine adhesions observed at hysteroscopy. Forty-three patients had mild or filmy intrauterine adhesions, 97 had moderate or fibromuscular adhesions, and 47 patients were classified as having severe connective tissue adhesions. After hysteroscopic treatment, normal menstruation was restored in 88.2% of patients who had menstrual abnormalities including amenorrhea, hypomenorrhea, and dysmenorrhea. Among the 187 patients, 143 women achieved pregnancy; of those, 114 (79.7%) achieved a term pregnancy, 26 (18.2%) had a spontaneous abortion, and 3 (2.1%) had ectopic pregnancies. The reproductive outcome correlated with the type of adhesions and extent of uterine cavity occlusion, ranging from a term pregnancy rate of 81.3% in patients with mild disease to 31.9% in patients with severe disease.

We propose a new scoring system for intrauterine adhesions (IUA) that may predict the prognosis after hysteroscopic adhesiolysis. We analyzed hysteroscopic findings and clinical data of patients diagnosed as having IUA by reviewing previously published hysteroscopic classifications of IUA. The data were subjected to evaluation according to the most popular classifications in addition to the proposed classification using a scoring system for different parameters. The results obtained by the proposed scoring system matched well with other classifications regarding grade I and III IUA. But in the cases with moderate IUA (grade II), there was overlap between the classifications (sensitivity 58.3%) which can be attributed to considering the menstrual and reproductive history. Further studies are needed to assess its prognostic value.Copyright 2000 S. Karger AG, Basel

To propose a new classification system (Urman‐Vitale Classification System) for intrauterine adhesions (IUAs) and to evaluate anatomical and fertility outcomes after hysteroscopic adhesiolysis accordingly.

Intrauterine adhesions (IUAs) and Asherman's syndrome (AS) have been recognized medical conditions since the late 19 and mid-20 centuries. Multiple classification systems have been proposed to better understand their severity and implications. This article aims to provide a comprehensive overview of the existing classifications for IUAs and introduces the Loddo scoring system, a novel approach for classifying these conditions. The Loddo scoring system is unique in amalgamating the strengths of previous classifications while emphasizing the importance of ultrasonographic endometrial thickness. This new system integrates various clinical parameters, offering a holistic representation of IUAs in clinical presentation and underlying structural changes. The Loddo scoring system presents a refined approach to understand and manage IUAs, providing a precise prognosis evaluation. Bridging the diagnostic and therapeutic divide seen in past systems, it offers promise for reshaping the landscape of diagnosis and treatment in women's health. Further research and validation are essential to assess its broad clinical applicability.Copyright: © 2025 Gynecology and Minimally Invasive Therapy.

The aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA).

Intrauterine adhesions (IUAs) caused by endometrial injury, commonly occurring in developing countries, can lead to subfertility. This study aimed to develop and evaluate a DeepSurv architecture-based artificial intelligence (AI) system for predicting fertility outcomes after hysteroscopic adhesiolysis.