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Treatment of uterine synechiae. Intrauterine synechiae

Intrauterine synechiae are most common different lengths and density. Located between the walls of the uterus, they reduce its cavity, in severe cases completely obliterating the uterus (obliteration - overgrowth). In addition, synechiae can appear in the cervical canal, which leads to its fusion. In this case, the entrance to the uterine cavity is closed. There is another name for this disease - Asherman's syndrome. Among patients who suffer from infertility, intrauterine synechiae is diagnosed in almost every second one.

Causes of the disease

Currently, infectious, traumatic and neurovisceral causes of intrauterine synechiae are distinguished. One of the main factors is considered to be previous trauma to the basal layer of the endometrium. This occurs, as a rule, as a result of termination of pregnancy, after diagnostic curettage, operations in the uterine cavity (myomectomy, conization of the cervix). Trauma or inflammation leads to damage to the endometrium, which causes the release of fibrin. As a result, the walls of the uterus “stick together” and adhesions form.

Also, the disease often develops against the background of a frozen pregnancy - the remains of the placenta cause the activity of fibroblasts and the appearance of collagen before the regeneration of the endometrium. In addition, the development of the disease is influenced by the use of an intrauterine contraceptive.

Adhesions also appear with genital tuberculosis, its presence is confirmed by the method bacteriological research or by endometrial biopsy. It should be taken into account that an unfavorable factor that increases the risk of developing the disease may be intrauterine instillations, radiotherapy for tumors of the uterus or ovaries.

Symptoms of the disease

There are various degrees severity of the disease.

At mild degree the disease may be asymptomatic. However, later, depending on the degree of spread, the symptoms of intrauterine synechiae become more varied. The patient experiences painful sensations lower abdomen, the intensity of which increases in critical days. At the same time, the duration of menstruation decreases, they become scanty, and in severe cases, amenorrhea develops (absence of menstruation in women of fertile age). Overgrowth lower section in the uterus with a normally functioning endometrium in the upper part leads to a disruption of the outflow of blood, as a result of which a hematometra can develop. The clinic resembles a painting acute abdomen, in this situation the patient needs emergency surgical care.

With extensive lesions in the uterine cavity with an insufficiently functioning endometrium, difficulties arise during implantation ovum. By the way, one of the reasons for the ineffectiveness of IVF - in vitro fertilization - is even mildly expressed adhesions. It should be taken into account that intrauterine synechiae are often accompanied by endometriosis (adenomyosis), which negatively affects the prognosis of treatment.

Patients often experience symptoms of intoxication, manifested by weakness, muscle pain, rapid heartbeat, as well as emotional instability.

Classification

Today there are various classifications intrauterine synechiae, giving full information about the disease: type of histological structure, area of ​​damage, etc. Since 1995, the classification proposed by the European Association of Gynecologists (ESH) has been used, which distinguishes five degrees based on hysterography and hysteroscopy data. This takes into account the length of synechiae, the degree of damage to the endometrium, and occlusion of the mouth of the fallopian tubes.

Complications

As a result of a lack of functioning endometrium, as well as the formation of adhesions, the fertilized egg cannot attach to the wall of the uterus. In addition, the fertilization process itself may be disrupted due to overgrowth fallopian tubes. In 30% of patients with diagnosed synechiae, spontaneous interruption pregnancy, 30% of women experience premature birth. Pathologies of the placenta often occur. Thus, complications of intrauterine synechiae are very numerous; pregnancy in such women is associated with great risk. But, in addition to miscarriage, there is a possibility of postpartum hemorrhage.

Diagnostics

Currently, there is no uniform examination algorithm. However, according to most doctors, the diagnosis of intrauterine synechiae should begin with hysteroscopy; in case of doubtful results, hystersalpingography is recommended.

  • Hysteroscopy - examination inner surface uterus using endoscopic equipment(hysteroscope). The technique allows you to perform not only visual inspection cavities and detect pathological changes, but also perform a biopsy or surgery if necessary. This minimally invasive procedure is practically painless and low-traumatic; it can be done either under local anesthesia, and under general anesthesia. The likelihood of complications after hysteroscopy is minimal.
  • Hysterosalpingography is in some cases more effective than hysteroscopy. With dense, multiple synechiae, dividing the uterine cavity into chambers of various sizes, and connected by ducts, this study is more informative. However, deformation of the uterine cavity, the presence of mucus and endometrial fragments, etc., in some cases can lead to a false positive result. Therefore, it is better to entrust the choice of a suitable research method to a specialist.
  • Ultrasound can detect single fusions, if there is no obstruction in the lower part of the cavity.
  • MRI with contrast is a fairly effective diagnostic method that allows you to visualize possible pathology.
  • Negative hormonal tests - when progesterone and estrogens are prescribed, there is no menstrual-like bleeding.

Treatment of intrauterine synechiae

The goal of therapy is to eliminate adhesions in the uterus and restore menstrual and reproductive functions. It must be emphasized that it is possible to decide how to treat intrauterine synechiae only after a thorough examination. Today, the only treatment method is dissection of synechiae. The nature of the operation depends on the type of adhesions, as well as the degree of damage. Weak synechiae are dissected with endoscopic forceps, scissors or the body of a hysteroscope; an electric knife or laser is used to remove denser strands. This intervention is a complex procedure, therefore, to prevent perforation of the uterine wall, it is carried out under visual control.

After surgery, hormone therapy is indicated, the purpose of which is to restore the endometrium. In the case where intrauterine synechiae arose as a result of infection, then after a biopsy and bacteriological examination, antibacterial drugs are prescribed.

Lightweight and average degree The disease is quite treatable. In situations where synechiae are located in a limited area, in vitro fertilization is effective.

Prevention

To reduce the risk of developing pathology, there are several simple rules:

  • Using competent contraceptive methods to prevent abortions
  • Intrauterine manipulations are best performed in clinics where there is modern equipment and qualified specialists
  • Timely treatment of urinary tract infections

It should be taken into account that in some patients, after treatment, there is a risk of developing a relapse, especially with dense widespread adhesions, as well as with tuberculous lesions. Therefore, the prevention of intrauterine synechiae after surgery plays a huge role. For these purposes, special devices are placed in the uterine cavity: IUD ( intrauterine contraception), Foley catheter. In addition, hormone therapy is performed to restore the endometrium.

You should also remember about existing risk in women with complicated course postpartum period or after an abortion. If there is a suspicion of placental remnants, if there is a violation menstrual cycle etc., hysteroscopy should be immediately performed, the purpose of which is to clarify the exact localization of the pathology focus and its removal without damaging the normal endometrium.

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Gynecology

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Intrauterine synechiae - adhesions in the uterine cavity.

The appearance of synechiae in the uterine cavity leads to atrophic changes in the endometrium, which entails disruption of menstrual function. In addition, intrauterine synechiae are a mechanical obstacle to the advancement of sperm, as a result of which the woman suffers from infertility. Also noted bad conditions for implantation of the fertilized egg, which leads to spontaneous abortion.

The trigger for the formation of intrauterine synechiae is damage to the basal layer of the endometrium, which, in turn, can be caused by various factors. The most common factors include:

  • surgical termination of pregnancy;
  • previous frozen pregnancy, in which possible remnants of the placenta in the uterine cavity contribute to the formation of collagen fibers;
  • presence of intrauterine contraceptives;
  • diagnostic curettage uterine cavity, carried out for endometrial polyps, fibroids, uterine bleeding and so on;
  • endometritis is an inflammatory disease that affects the endometrium;
  • genital tuberculosis;
  • radiation therapy, carried out at malignant formation uterus or ovaries.

With timely detection, the prognosis of the disease is favorable, in most cases it is possible to restore menstrual and reproductive function. An unfavorable outcome is observed with intrauterine synechiae of tuberculous etiology. In this case, it is extremely rare to restore the condition of the endometrium. In addition, after dissection and removal of synechiae of any origin, there is a risk of the formation of new ones. Since intrauterine synechiae are a mechanical obstacle to the advancement of sperm, women often suffer from infertility. In this regard, such patients are offered auxiliary reproductive technologies, including in vitro fertilization. However, unfortunately, in some cases even with the help assistive technologies women are unable to bear fruit. In this case, it is proposed to consider the option of carrying a fetus through surrogacy.

Symptoms


As a rule, the presence of intrauterine synechiae is manifested by the development of hypomenstrual syndrome. This syndrome is characterized by the following:

  • rare and short menstruation;
  • low blood loss during menstruation compared to the physiological norm.

IN in rare cases in women with intrauterine synechiae, secondary amenorrhea is noted ( pathological condition, characterized by prolonged absence of menstruation in women who previously menstruated). When the lower parts of the uterine cavity are obliterated during menstruation, a hematometra can form - an accumulation of blood in the uterine cavity, resulting from a violation of its outflow. This phenomenon is accompanied by the appearance pain in the lower abdomen. In most cases, the pain is cramping in nature.

Since the presence of intrauterine synechiae prevents implantation of the fertilized egg, women often suffer from infertility or miscarriage. The formation of synechiae in the fallopian tubes makes the process of fertilization impossible, which also leads to infertility. In such cases, techniques can be used artificial insemination however, unfortunately, the presence of even the most minimal synechiae in the uterine cavity disrupts the implantation process, which can cause ineffective in vitro fertilization.

Diagnostics


Diagnosis begins with clarification of the patient’s complaints, in particular assessment of menstrual and reproductive function. You should also find out whether the woman has a history of abortions, intrauterine manipulations, for example, endometrial curettage, or inflammatory diseases of the reproductive organs. This is important to know, because listed factors often cause the development of intrauterine adhesions.

Unfortunately, ultrasound of the pelvic organs in in this case is a low-informative study, since the presence of intrauterine synechiae can be indirectly judged only by the irregular contours of the endometrium. The presence of a hematometra, which is expressed as an anechoic formation in the uterine cavity, is clearly visualized on ultrasound. The most informative are the following studies:

  • hysteroscopy – endoscopic method research that allows you to examine the uterine cavity using a hysteroscope. In the future, if necessary, not only diagnostic procedures, but also therapeutic ones can be carried out. Intrauterine synechiae are visualized as avascular whitish cords. These cords have different densities and lengths and connect the walls of the uterus. Due to their presence, deformation or obliteration of the uterine cavity is noted;
  • Hysterosalpinography is an x-ray examination method that allows you to assess the patency of the uterus and fallopian tubes. However, it is worth noting that in some cases this study gives a false positive result due to the presence of mucus, endometrial debris, and so on in the uterine cavity.

Hormonal tests may also be prescribed, which are assessed by the presence of menstrual-like bleeding in response to estrogen and progesterone. In this condition, the hormonal test will be negative. In addition, the level of sex hormones is assessed, which is within normal limits, which indicates the normogonadotropic nature of amenorrhea.

Treatment


The main goal of treatment is to eliminate existing intrauterine synechiae, thereby restoring menstrual and reproductive function.

By far the most effective method is to perform surgical hysteroscopy, during which adhesions are dissected under the control of an optical device. Hysteroresectoscopy allows you to eliminate the existing problem without resorting to more complex interventions. Since this manipulation is considered minimally invasive, as a rule, the development of any complications is extremely rare in the future.

After surgical manipulation, the woman is prescribed hormone therapy, the effect of which is aimed at stimulating the restoration of the endometrium, as well as its cyclic transformation. It is important to note that under no circumstances should you use combined oral contraceptives, since these drugs act on the endometrium, causing it atrophic changes.

Since the formation of synechiae in the uterine cavity is often associated with inflammatory diseases of the genital organs, it is important to use antibacterial agents, the action of which is aimed at destroying pathogenic microflora. To avoid the development of a chronic form of inflammatory disease, which is often the cause of the appearance of intrauterine synechiae, it is necessary to carefully follow all the doctor’s recommendations during treatment of the acute form of the disease. You should also be careful when taking antibiotics; in particular, you should never discontinue the drug yourself or adjust the dosage and frequency of administration. In addition, after relief of acute inflammatory process physiotherapeutic treatment is prescribed, which reduces the possibility of the formation of adhesions in the pelvis. The following types of physiotherapy are used:

  • UHF is a physiotherapeutic treatment method based on the use of an ultra-high frequency electromagnetic field;
  • Magnetic therapy is a physiotherapeutic procedure based on the effect on the body magnetic field;
  • electrophoresis with magnesium, zinc or hyaluronidase - introduction medicine through the skin or mucous membranes using constant electric current;
  • Diadynamic therapy is a method of physiotherapeutic treatment based on the use of electrical currents of various frequencies and powers.

Medicines


As is known, the main method of treating intrauterine synechiae is their dissection and removal during hysteroresectoscopy. After this surgical procedure, the woman is prescribed hormone therapy, which helps restore the endometrium. Selection hormonal drugs carried out by a specialist strictly individually in each individual case. During your appointment hormonal drugs You should carefully follow all the doctor’s recommendations, and also not self-medicate, in particular, do not adjust the dose of medications or stop taking them without the knowledge of your doctor. Under no circumstances should combined oral contraceptives be used, since these drugs, on the contrary, cause atrophic changes in the endometrium.

If the disease is infectious, antibacterial agents are prescribed, the action of which is aimed at destroying pathogenic microflora. The choice of a specific group of antibiotics is based on the results of a study of scrapings from cervical canal and cervix. Based on this study manages to highlight pathogenic microorganisms, which were the cause of the development of the inflammatory disease, and also determine their sensitivity to the antibiotics used. As a rule, until the results of the study are available, preference is given to antibacterial drugs wide range, acting on both gram-positive and gram-negative microflora.

Folk remedies


Folk remedies are not used in the treatment of intrauterine synechiae, but their use can be encountered in the treatment of inflammatory diseases of the organs reproductive system, since they are often the cause of the adhesive process. In this case, the means traditional medicine based on plant components are used for preventive purposes. It is also worth noting that these drugs should be used exclusively as an addition to the main treatment prescribed qualified specialist. We bring to your attention the following recipes, before using which you should consult with your doctor:

  • To prepare the infusion you will need: 1 tablespoon of chamomile, 2 tablespoons of marshmallow leaves and 1 tablespoon of sweet clover herb. Mix the listed components thoroughly and pour in 1 cup of boiling water, let it brew for 20 minutes, then strain through a strainer. It is recommended to take ¼ cup 2 times a day after meals;
  • mix 6 tablespoons of oak bark and 4 tablespoons of linden flowers. From the resulting collection, to prepare the infusion, you will need 4 tablespoons of raw materials, which are poured with 1 liter of boiling water and infused for 5 minutes, after which the infusion is carefully filtered. It is recommended to use for douching 2 times a day;
  • take 4 tablespoons of dried chamomile flowers, pour 1 glass of boiling water over them, let it brew for 10 - 20 minutes. The infusion becomes ready for use after careful straining. It is recommended to take ½ glass orally 2 times a day;
  • Take 1 tablespoon of pre-prepared plantain leaves, pour two glasses of boiling water, let it brew for 15 - 20 minutes, then strain through a strainer. The resulting infusion is consumed 1 tablespoon 3 – 4 times a day.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

First, let's define a new term - synechia. Synechiae are pathological fusions of the surfaces of the same organ or the contacting surfaces of different organs.

Frequency of intrauterine synechiae in women with infertility is 55%. More often this pathology combined with tubo-peritoneal factor of infertility.

The mechanism of infertility with uterine synechiae

As we know, the uterine cavity is the abode of the intrauterine developing baby. Because it's a violation anatomical structure uterus causes difficulty in the implantation of a fertilized egg and the development of pregnancy.

Causes:

Without endometrial trauma, the formation of synechiae in the uterine cavity, even in the presence of inflammation, is almost impossible. Adhesions in the uterine cavity occur as a result mechanical impact on the basal layer of the endometrium, which most often occurs during curettage, especially in the early postpartum period. Intrauterine synechiae can be the result of surgical interventions, the presence foreign bodies in the uterus ( intrauterine device, remains of fetal fragments after abortion), as well as irrational medical manipulations in the uterine cavity (intrauterine administration of various medications for therapeutic purposes).

The second most important factor in the formation of intrauterine synechiae is chronic endometritis. In women with primary infertility and the absence in the past of any manipulations in the uterine cavity, intrauterine synechiae are the result of only one specific pathological process- tuberculous endometritis.

Diagnostics

Clinical picture and complaints:

Important information for a gynecologist is the presence of a history of curettage of the uterine cavity due to artificial or spontaneous abortion, as well as other medical intrauterine manipulations. Women with synechiae in the uterine cavity often complain of pain in the lower abdomen, which intensifies during menstruation. The intensity of pain may vary. Greater pain intensity is achieved with synechiae localized in lower third uterus and cervical canal, making it difficult to pass menstrual flow. If the outflow of menstrual fluid is not impaired, the pain is not expressed.

Many patients with intrauterine synechiae complain about changes in the nature of menstruation. Menstruation becomes less abundant and shorter. With significant damage to the endometrium, they pass in the form of a “daub.” In especially severe cases, when the uterine cavity or cervical canal is completely closed, menstruation disappears (uterine form). In patients with atresia (fusion) of the cervical canal and absence complete defeat endometrium, c normal function ovaries there are complaints of recurring monthly cyclical pain in the lower abdomen on the days of expected menstruation.

Instrumental methods research:

X-ray methods: performed by hysterosalpingography - with the introduction of contrast into the uterine cavity and a series of X-ray images. Signs of synechiae are filling defects or complete absence filling the uterus with contrast.

Ultrasound. The diagnostic value of ultrasound for identifying intrauterine synechiae is 60-70%. For women with amenorrhea and suspected intrauterine synechiae, it is better to have an ultrasound scan on the days of expected menstruation, and if the menstrual cycle is intact, twice: on days 8-12 of the cycle and at the end of the cycle. On ultrasound, synechiae may look like constrictions that deform the uterine cavity.

Echohysterosalpingoscopy. After dilation of the uterine cavity liquid medium intrauterine synechiae are visualized as hyperechoic inclusions, constrictions that deform the cavity. The diagnostic value of the method in identifying intrauterine synechiae reaches 96%.

Magnetic resonance imaging. If necessary, it can be used to diagnose intrauterine synechiae.

Hysteroscopy. If synechia is suspected, it is carried out in a hospital in the first phase of the menstrual cycle. During this period, against the background of a thin endometrium in the uterine cavity, intrauterine synechiae are clearly visible.

Treatment

Medicinal preoperative preparation

Only effective surgical treatment However, preoperative preparation and postoperative treatment are carried out with medication.

Preoperative preparation. Purpose preoperative preparation to hysteroresectoscopy is the creation of reversible endometrial atrophy to ensure optimal conditions surgical intervention. It is carried out with hormonally active drugs that affect the condition of the endometrium. The growth and maturation of the endometrium is suppressed.

Surgical intervention
A surgical operation to eliminate intrauterine adhesions and restore the patency of the uterine cavity is called hysteroresectoscopy. This operation It is performed using special endostotic equipment through transvaginal access.

Postoperative treatment

Early rehabilitation treatment begins from the first day of the postoperative period, using physical and medicinal methods.

Antibacterial therapy is indicated in early postoperative period.

Physiotherapy improves healing processes, increases local immunity, prevents the formation of new intrauterine synechiae and the development of adhesions in the pelvis. Treatment begins no later than 36 hours after surgery. They use an alternating magnetic field of low frequency, a constant magnetic field, currents of supra-tonal frequency, laser exposure.

What treatment is prescribed after surgery?

A repeated course of physiotherapy begins on the 5th-7th day of the menstrual cycle following surgery. The number of physiotherapy courses is determined individually. If necessary, up to three courses are carried out with an interval of at least 2 months between them.

Cyclic or replacement hormone therapy(HRT). It is performed in the treatment of women with intrauterine synechiae that arise against the background of a chronic inflammatory process. HRT promotes the full restoration of the uterine mucosa and its complete rejection during menstruation, prevents re-education synechiae in the uterine cavity, improves metabolic processes in the endometrial tissues of the uterus, which creates a favorable environment for pregnancy.

Immunomodulators are selected taking into account indicators of immune and interferon status determined before the start of surgery and drug treatment.

After graduation rehabilitation treatment carry out additional examination, which consists in assessing the condition of the uterine cavity. Based on X-ray examination, echohysterosalpingoscopy or control hysteroscopy, an objective picture is drawn up results achieved. In cases of incomplete separation of intrauterine synechiae, repeated surgery and subsequent conservative complex treatment.

In the absence pathological changes The patient is observed in the uterine cavity for 6 months (waiting period for pregnancy). Dynamic observation involves monitoring ovulation and ultrasound monitoring of the condition of the endometrium during the menstrual cycle.

Expectant management for 6 months is indicated provided that ovulation is present, the man is not infertile, and adequate monthly cycle. If the ultrasound parameters of the endometrium do not correspond to the abundance of menstrual flow, it is necessary to repeat therapeutic effect aimed at improving trophic processes in the uterus (physiotherapeutic and hormonal treatment).

If ovulation defects are detected, it is stimulated for four consecutive cycles. If pregnancy does not occur within the specified period of time, additional examination is necessary to identify and analyze the reasons for unsuccessful treatment.

Intrauterine synechiae (Asherman's syndrome) or so-called adhesions inside the uterus are complete or partial occlusion of the uterine cavity.

Causes of synechiae

Today, several theories of the formation of intrauterine synechiae are known: traumatic, infectious and neurovisceral. According to the traumatic theory, the key trigger that triggers the process of synechiae is traumatic injury basal layer of the endometrium. Mechanical trauma is possible due to difficult childbirth or frequent curettage of the uterine cavity, as well as abortion. In this case, infection is a secondary factor in the occurrence of uterine synechiae. Also, synechiae of the uterine cavity can form in women whose gynecological history is burdened by a frozen pregnancy. This is possible because the remaining placental tissue may contribute to the activation of fibroblasts and collagen synthesis even before the process of regeneration of the inner layer of the uterus (endometrium).

The cause of synechiae that forms inside the uterine cavity can be various surgical procedures and interventions on the uterus: diagnostic and therapeutic curettage of the uterine cavity, hysteroscopy, myomectomy, metroplasty. Synechiae are often observed after conization of the cervix or severe endometritis. Frequent provoking factors for the formation of synechiae of the uterine cavity include the introduction or removal of intrauterine contraceptives (spirals), as well as the installation of the Mirena system for therapeutic purposes.

Classification of intrauterine synechiae

In practice, gynecologists use special classification, in which Synechiae are divided according to their prevalence and degree of involvement in the pathological process of the uterus:

  • Degree I is characterized by the involvement of no more than 1/4 of the volume of the uterine cavity in the pathological process, intrauterine adhesions are thin in diameter, and the fundus of the uterus and the mouth of the fallopian tubes are free.
  • II degree - intrauterine synechiae extends to no less than 1/4 and no more than 3/4 of the volume of the uterine cavity. The walls of the uterus do not stick together; there are only thin adhesions that partially cover the fundus of the uterus and the openings of the fallopian tubes.
  • Stage III is characterized by the involvement of more than 3/4 of the entire uterine cavity in the pathological process.

Clinical manifestations of intrauterine synechiae

The clinical picture of synechiae located inside the uterine cavity depends on the extent of damage to the uterine cavity by the pathological process. Most common clinical manifestations intrauterine synechiae are amenorrhea or hypomenstrual syndrome. The result of a long and neglected process of synechiae being inside the uterine cavity is infertility, or the inability to bear a child. In cases where there is an infection of the lower parts of the uterus with the internal endometrium functioning normally in the upper parts, a cavity filled with blood (hematometra) can form. If the uterine cavity is significantly enlarged and the inner layer of the uterus is poorly functioning, the process of embryo implantation into the uterine cavity becomes difficult. Also, intrauterine synechiae, even of small diameter, can cause ineffective in vitro fertilization.

Diagnosis of intrauterine synechiae

To remove synechiae, it is necessary to clearly establish their location and the extent of damage to the uterine cavity by synechiae. To diagnose synechiae, the following research methods are used:

Examination for the presence of intrauterine synechiae begins in cases where there are problems with conception. To date, there is no specific developed plan for examining such women. Many practicing doctors believe that it is better to start diagnosing intrauterine synechiae with hysteroscopy, and if a questionable result is obtained, hysterosalpingography should be performed.

Diagnostic hysteroscopy

Hysteroscopy today in practical gynecology is key method diagnosis of synechiae inside the uterine cavity. In this study, intrauterine synechiae are presented in the form of cords white without vessels of different lengths. These pathological adhesions of dense consistency, located throughout the entire length between the walls of the uterus, can cause a decrease in its size due to complete or partial obliteration of the uterine cavity. Synechiae can also be localized in the cervical canal, which causes closure of the cervical canal and difficulty entering the uterine cavity. Intrauterine synechiae of thin diameter are presented in the form of strands of pale pink color, sometimes they look like a cobweb, in which the vessels passing through it are visible.

Hysterosalpingography

With hysterosalpingography, the signs of synechiae of the uterine cavity clearly depend on their nature and distribution. As a rule, intrauterine synechiae on hysterosalpingography are presented in the form of single or multiple filling defects that have an irregular shape. More often, synechiae of the uterine cavity appear as lacunae-shaped defects of various sizes. Intrauterine synechiae have a dense consistency and divide the uterus into numerous chambers. different sizes, which are connected to each other only by small-diameter ducts. This configuration of the uterine cavity is not completely visualized when diagnostic hysteroscopy, since during this research method only the first few centimeters are examined lower section uterus. While with hysterosalpingography contrast agent of a viscous nature bypasses all the complex labyrinths of the uterine cavity affected by synechiae and the non-obliterated spaces of the uterus. This method of radiographic examination has negative qualities. It may give false-positive results due to remnants of the inner layer of the uterus (endometrium), mucus, or deformation of the uterine cavity by synechiae.

Ultrasound examination of the pelvis

Currently, even advanced ultrasound equipment when detecting intrauterine synechiae does not provide complete information about the state of the uterine cavity and the doctor does not receive an objective picture of what is happening. IN in some cases it is possible to visualize the unclear contours of the inner layer of the uterus, and in the presence of a hematometra, an anechoic formation is detected that completely fills the uterine cavity. Hydrosonography can detect single synechiae of the uterine cavity when there is no complete obstruction in the lower segment of the uterus. Dense intrauterine synechiae are characterized as white cords of dense consistency, which are often localized along the side walls. They are located very rarely in the central part of the uterus. Large quantity synechiae of a transverse direction lead to partial or complete closure of the uterine cavity in the form of numerous cavities of different sizes. These cavities are sometimes mistaken for the openings of the fallopian tubes.

Treatment of intrauterine synechiae

Today, the only correct solution for the treatment of synechiae of the uterine cavity is dissection of the synechiae under the careful control of a hysteroscope, which does not injure the remnants of the endometrium, which is important for normalizing the menstrual cycle and maintaining a woman’s reproductive function. The volume of operations to separate synechiae and its effectiveness depend on the type of synechiae and the degree of obstruction of the uterine cavity by synechiae.

Intrauterine synechiae, which are localized in the central part of the uterus, can only be cut in a blunt manner using the body of a hysteroscope. Also, special endoscopic scissors and forceps are used to separate synechiae. In this case, a hysteroresectoscope with an electrode (“electronic knife”) is used to completely dissect the synechiae of the uterine cavity.

In order to prevent uterine perforation, dissection of synechiae is performed under constant and careful monitoring of ultrasound equipment. Such separation of synechiae is possible only with partial obstruction of the uterine cavity. While in case of complete or significant occlusion of the uterine cavity by synechiae, control over the progress of the operation is performed through laparoscopic access using special equipment.

Despite the greater effectiveness of hysteroscopic treatment, relapse of the pathological process is possible. More often, intrauterine synechiae can recur with compacted adhesions, as well as uterine tuberculosis. After dividing the synechiae, the doctor prescribes hormonal therapy (oral contraceptives in large dosages) to each patient individually. This therapy prescribed for 3-6 months to restore normal menstrual function.

Prognosis for synechiae inside the uterine cavity

A positive result after hysteroscopic dissection of synechiae depends on the duration and prevalence of intrauterine synechiae. For example, the more the uterine cavity is obstructed by synechiae, the less effective the treatment is. The worst possible results in normalizing menstrual function and restoring a woman’s reproductive function are observed with synechiae of the uterine cavity of a tuberculous nature.

Women who underwent surgical treatment with a history of synechiae, during pregnancy they are at risk for complications during pregnancy, delivery and the early postpartum period. In 35% of pregnant women who have synechiae inside the uterine cavity, spontaneous abortion occurs. In 30%, labor begins before the due date, while the remaining 35% of pregnant women develop placental pathology (solid or partial placenta attachment or placenta previa).

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Synechiae are acquired or congenital fusions of adjacent organs or their surfaces. Often synechiae occurs in children, especially in girls - fusion of the labia minora.

And intrauterine synechiae also occurs in adult women. Let's talk about this pathology and treatment methods - separation of synechiae and removal of synechiae.

Intrauterine synechiae is a condition characterized by complete or partial occlusion of the uterine cavity. Intrauterine synechiae are one of the possible reasons development of infertility.

The main factor in their development is considered mechanical injury of various origins of the basal layer of the endometrium of the uterus (after abortion or childbirth, operations on the uterus), and infection is a secondary factor. The first month after childbirth or abortion is considered the most dangerous in terms of possible trauma to the uterine mucosa.

Symptoms of intrauterine synechiae appear depending on the degree of uterine infection. Most often, hypomenstrual syndrome is observed with the development of infertility or miscarriage.

Treatment of this disease comes down to dividing the synechiae or removing the synechiae.

Based on the histological structure, there are three types of intrauterine synechiae:

1. Light type - synechiae in the form of a film, usually consisting of the basal endometrium; dissection and separation of synechiae does not cause difficulties.

2. Medium type- synechiae of a fibromuscular structure, covered with endometrium; when cut, the synechiae bleed.

3.Heavy type– dense, connective tissue synechiae. As a rule, when dissected, synechiae do not bleed and are difficult to dissect.

Dissection of synechiae is carried out under visual control of a hysteroscope, which avoids additional trauma to the endometrium and helps restore fertility and the normal menstrual cycle.

Separation and separation of synechiae are carried out various methods, and the nature of the operation depends on the type of synechiae formed inside the uterine cavity and the degree of occlusion of its cavity.

Separation of centrally located synechiae can be carried out using endoscopic scissors or forceps.

Centrally located synechiae can be divided bluntly using the hysteroscope body. For dissection, dilution and removal of synechiae more than dense structure A hysteroresectoscope with an electrode is used - a laser conductor or an “electronic knife”. To prevent uterine perforation, surgery is often performed under ultrasound guidance or, in case of significant occlusion, under laparoscopic guidance.

Despite high efficiency hysteroscopic removal of intrauterine synechiae, recurrence of the disease is not excluded - especially in the presence of dense widespread synechiae, as well as in patients with tuberculous lesions of the uterus.

In order to reduce the risk of relapses after dissection, separation and removal of synechiae, hormonal therapy is carried out (prescribed in high doses estrogen-gestagens).

Thus, pregnancy in women with intrauterine synechiae has high risk the development of complications, both during pregnancy and during childbirth and the postpartum period.