Revisiting Diagnostic and Therapeutic Challenges in Asherman's syndrome: A Retrospective Analysis of 5 years

Aim: To Analyse the Etiologies, clinical features, diagnostic modalities used and the therapeutic outcome following Hysteroscopic adhesiolysis among women with Asherman’s Syndrome, managed at our Hospital during 5 years (1st March 2013 to 31st March 2018). Material and Methods: A Retrospective Cross sectional Study of 5 years was conducted and those Women who had undergone Hysteroscopic adhesiolysis for Asherman's syndrome were selected. Case records of these women were retrieved from Medical Record Department. Sociodemographic, clinical, Obstetric profile, Hysteroscopic findings, details of adhesiolysis, changes in menstrual pattern and Fertility outcomes were recorded. Results: The leading cause for Asherman’s was D&C (62%) and followed by Tuberculosis (19%).TVS assessment of Endometrial thickness was 64% diagnostic for moderate Asherman’s, if there is thin ET with few echogenic shadows and Doppler flow is impaired and irregular, echogenic ET (<2 mm) with High resistance doppler flow is diagnostic for severe Adhesions in 87.5%(p<0.001). Myometrial thickness assessement called RR method (named after authors) guided the amount of adhesiolysis and none of our women required laparoscopic assisted hysteroscopic adhesiolysis. Repeat Second look Hysteroscopies carried good results, 100% adequate cavity and menses restoration occurred after second look Hysteroscopies. Conception rate was 38% and term Pregnancy rate was 67%, majority of conception occurred in severe adhesion group. Obstetric complications can occur following adhesiolysis. Role of IUCD vs Foleys and E+P vs E+P with stem cell instillation were equally efficacious. Conclusion: skilled Hysteroscopy is the Gold standard for diagnosis and treatment of Asherman’s syndrome