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On the left tubal angle there are single intrauterine planar adhesions. Dissection of synechiae

Intrauterine synechiae are fusions of cavity tissues with each other, which entails partial or complete fusion of the entire uterus. This problem needs to be eliminated by mandatory, otherwise a woman is unlikely to be able to get pregnant and bear a healthy fetus. Therefore, removal of synechiae in the uterus must be done promptly and with the help of a qualified doctor.

Reasons for the formation of synechiae

There are a number certain factors, which can provoke the formation of synechiae in the uterine cavity of any woman.

Let's list these reasons:

  • Mechanical damage. They can be provoked by abortion (rough curettage of the fetus), severe pregnancy, removal benign formations, conization of the cervix, metroplaty, surgery on the walls of the uterus, incorrect placement intrauterine device etc.
  • Infectious and inflammatory processes. Endometritis, chronic course the development of chlamydia and other diseases will become an obvious cause for the degeneration of the endometrial layer and the formation of synechiae.
  • Frozen pregnancy. Leftovers placental tissue cause activation of fibroblasts and formation of collagen to produce synechiae in the uterine cavity.

As you can see from the list, there are plenty of reasons for getting such an unpleasant illness. But the most important thing is that initial stage the formation of synechiae is invisible to a woman and is very important at the very first unpleasant symptoms contact the clinic to provide qualified medical care.

Symptoms of the disease

The fusion of uterine tissue can be detected using preventive gynecological examination, therefore, every woman should not neglect the golden rule: she must visit a gynecologist 2 times a year. Also, one of the visible symptoms of the disease is scanty menstruation or its complete absence. Termination menstrual cycle threatens to accumulate menstrual blood in the uterus, which will lead to disastrous consequences.

Also final stages During the course of the disease, a woman may feel unpleasant pain in the abdominal area.

Stages of disease development

It is used in the treatment of synechiae to identify varying degrees of prevalence and occupancy of the uterine cavity.

There are 3 degrees of development of the disease:

  • There are thin adhesions, ¼ of the volume of the uterine cavity is involved.
  • The adhesions have a denser structure, but there is no adhesion of the walls yet; up to ¾ of the uterine cavity is involved.
  • Dense adhesions are observed, more than ¾ of the uterine cavity is involved.

The last stage is very dangerous and threatens the woman with infertility.

Diagnostics

You can begin treatment for synechiae only after a thorough diagnosis. The patient will need an ultrasound, hysterosalpingography (x-ray of the uterus) and hysteroscopy (examination of the uterus using a tiny video camera inserted into the woman's vagina). After receiving all the results of the study, the doctor will prescribe the correct and effective treatment.

Treatment

Removal of synechiae in the uterus occurs using a hysteroscope or endoscopic instruments. Removal of synechia of the uterine cavity is a painless procedure.

A hysteroscope is used if synechiae have the first degree of damage to the uterine cavity. The hysteroscope is inserted into the vagina and the body of the device carefully dissects thin and delicate adhesions. In this case, the procedure is very safe, painless and not accompanied by bleeding.

Endoscopic instruments, such as microscissors, are used by the doctor to remove grade 2 and 3 synechiae. Medical manipulation does not require application general anesthesia. The essence of the procedure is as follows: microscissors are passed through the channels of the endoscopic unit and the neoplasms are dissected with special care so as not to cause additional harm to the uterus. Such an operation requires high qualifications of the attending physician, since dissection of synechiae of degrees 2 and 3 is fraught with the occurrence of heavy bleeding.

To avoid relapses, a special gel-like filler is injected into the woman’s uterine cavity at the end of the procedure. It will help avoid re-fusion of the walls and the formation of adhesions. Hysteroresectoscopy of synechiae in the uterine cavity is performed on the eve of menstruation.

Postoperative period

In the postoperative period, it is necessary to take antimicrobials to prevent the occurrence of an inflammatory and infectious process. Also, in addition to antibiotics, the attending physician will prescribe hormonal therapy for a speedy recovery. female body without causing unwanted side effects.

A short time after the procedure, the woman will be required to visit a gynecologist for a repeat hysteroscopy. It will help determine the condition of the uterine cavity after removal of synechiae, evaluate the results of treatment and avoid relapse.

Is it necessary to remove intrauterine synechiae? Of course yes! And the sooner the better. For those who have been diagnosed with synechiae of the uterine cavity, reviews after treatment always turn out to be two stripes on the havidar test!

With normal sexual development of a child, the posterior commissure of the vagina limits the entrance to its vestibule, while the labia minora have a thin layer of epithelium and are adjacent to each other. If the vulva is in order, then there is a clear demarcation of the labia minora from the labia majora and the genital fissure is visible, which allows an unobstructed examination of the vagina.

Dissection of synechiae of the labia minora - removal of adhesions of the vulva or vestibule of the vagina, which are expressed in fusion of the labia minora (sometimes fusions are observed big lips with small ones).

With the development of disorders, fusion of the labia occurs, and in more complex cases, the union of the labia minora and majora occurs. Fusion can occur from the first days of a child’s life or during development. The first symptoms are a rash, redness and peeling in the intimate area.

The formation of adhesions causes difficulty urinating, and with the development of pathologies, urine flows into the vagina, which contributes to the development of inflammatory diseases.

Symptoms of the disease

In most cases, the appearance of synechiae can be asymptomatic, which complicates their diagnosis and contributes to the development of complications. The main symptoms of the development of the disease include:

  • frequent urge to urinate;
  • constant leakage of urine, although the child constantly goes to the potty;
  • the stream of urine is directed upward, not downward;
  • the girl feels discomfort (constantly fidgets on the potty, complains of pain, cries, strains);
  • redness of the genitals and the appearance of a rash, itching;
  • washing is painful, the child cries constantly;
  • spreading the labia apart causes pain and only part of the vagina is visible.

Why do synechiae occur?

Experts identify the following factors that provoke lip fusion:

  • Violation of hygiene rules. Frequent washing with soap can damage the mucous membrane of the vulva and contribute to the formation of microcracks and wounds. Insufficient washing promotes the development of pathogenic organisms.
  • Infectious diseases. A child can become infected with a sexually transmitted infection during childbirth, by using a shared washcloth or towel, or by swimming in a natural body of water.
  • Allergic reaction. Allergies can affect not only the child’s skin, but also mucous membranes. At the same time food allergens most often cause fusion of the genital organs. The disease can develop as allergic reaction for diapers, washing powder, soap and other products.
  • Hormonal imbalances. The disease develops with a lack of the hormone estrogen.
  • Pregnancy occurring with intrauterine infection.
  • Wrong choice underwear and diapers. When the genitals are rubbed, microcracks are formed, which promote fusion of the lips. Overheating of a child causes diaper rash, which negatively affects the genitals.

Diagnosis of synechiae of the labia

Only a doctor can make a diagnosis - synechia of the labia, after visual inspection and a number medical research. Self-diagnosis and treatment of the disease can lead to a deterioration in the child’s condition.

For staging accurate diagnosis necessary:

  • visual examination of the lips by a pediatric gynecologist;
  • vulvoscopy (non-contact colposcopic examination of the external genitalia using an optical device);
  • serological examination of smears and detection bacterial causes inflammation;
  • tests for urogenital diseases (chlamydia, mycoplasmosis and others);
  • blood and urine tests;
  • checking blood sugar;
  • checking for invasive diseases (detection of worms and dysbacteriosis);
  • if available congenital anomalies carried out ultrasound examination pelvic organs.

How is synechiae dissected?

Depending on the indications and degree of development, treatment can be carried out in the following ways:

  • the use of special ointments;
  • dilation of lip adhesions.

If the process of fusion of the labia minora is detected in a timely manner, hormonal ointments, which contain estrogen, dissolve the formed film and promote separation. At the core drug treatment ointments should be applied to the perineal area for 3-4 weeks.

If synechiae does not cause discomfort or harm health, then the doctor can use a wait-and-see approach with constant medical monitoring of the child’s condition. This technique is based on the independent production of the hormone estrogen during puberty.

Removal of synechiae is a last resort in treatment and is taken only in case of disruption of the urination process or lack of effect from the use of medicinal creams, when the film becomes very dense. The operation is painless and safe for the child, but the rehabilitation process is very long and unpleasant.

Surgical treatment includes:

  • general or local anesthesia;
  • treating the genitals with an anesthetic;
  • removing the film with a scalpel within a few seconds;
  • wound treatment antiseptic;
  • rehabilitation period (treating wounds with a special cream, taking antibiotics in the form of an ointment, sitz baths).

Surgical intervention to remove genital fusions in children younger age may be accompanied psychological trauma(because of severe pain after surgery), the occurrence of relapses of the disease.

It is worth remembering that successful treatment does not guarantee the absence of fusion in the future. It is necessary to carry out constant monitoring for health, since up to 8 years of age the possibility of exacerbation of the disease remains. With age, the mucous membrane of the vulva thickens, which reduces susceptibility to irritating environmental factors.

Intrauterine synechiae (Asherman's syndrome) are intrauterine adhesions between individual sections of the uterine mucosa, leading to complete or partial obliteration (clogging) of the uterine cavity. In the presence of synechiae, the normal endometrium may undergo atrophic changes. Intrauterine synechiae lead to disorder menstrual function, create mechanical obstacles to the advancement of sperm, worsen the conditions for implantation of the fertilized egg.

The presence of this syndrome may interfere in vitro fertilization. This leads to the main manifestations of Asherman's syndrome - hypomenorrhea ( scanty menstruation), secondary amenorrhea (cessation of menstruation), algodismenorrhea ( painful menstruation), spontaneous abortions, miscarriage, infertility, sometimes hematometra develops (accumulation of blood in the uterine cavity).
To confirm the diagnosis and to establish the exact localization of adhesions, ultrasound, hydrosonography, and diagnostic hysteroscopy are prescribed.

Reasons for the formation of synechiae

Most common cause Asherman's syndrome is caused by previous mechanical injuries of the basal endometrium. Injury to the endometrium can occur due to surgical termination of pregnancy, the use of intrauterine contraceptives, diagnostic curettage cavity, operations in the uterine cavity (myomectomy, metroplasty). Damage to the endometrium can be aggravated by the addition of infection with the development of endometritis. The development of intrauterine adhesions can be promoted by genital TB, intrauterine instillations, radiation therapy regarding tumors of the uterus and ovaries. Often the formation of intrauterine synechiae occurs against the background of a previous frozen pregnancy.

Classification of intrauterine adhesions

The main classification criterion is how closed the organ cavity is, how much it is affected pathological changes. It is customary to distinguish 3 degrees of intrauterine synechiae:

  • First. The most light form, in which less than ¼ of the uterine cavity is involved, the adhesions are thin, the mouth fallopian tubes free.
  • Second. It is diagnosed if from 14 to 34 uterine cavities are involved, and the mouths of the tubes are blocked, although not completely.
  • Third. More than 34 uterine cavities are involved, i.e. the uterine cavity is almost completely closed.

Surgical treatment

The only one effective method treatment - dissection of intrauterine synechiae. The operation is carried out under the control of a hysteroscope: this is a tube with a light source, a camera and surgical instrument, allowing you to display an image of the uterine cavity on the screen. It is preferable to use mechanical separation of synechiae, but the intervention may also require a hysteroresectoscope - “electronic knife”. The operation is safe, healthy tissue is almost not damaged, therefore recovery period short after it.

To prevent perforation of the organ, dissection of intrauterine synechiae is carried out under the control of ultrasound equipment. And in order to prevent relapse, after the intervention a course of hormonal therapy is prescribed or an IUD is inserted for 1-2 months. The prognosis is usually favorable, but it depends on the extent of the lesion. The easier the degree, the easier operation and lower risk of complications. After dissection of synechiae of degrees 2 and 3, it is advisable to perform a control hysteroscopy in 2-3 months. You can plan a pregnancy after menstrual function has been restored (usually after 3-4 months). But even with successful therapy, women who have a history of uterine fusions require special attention from obstetricians and gynecologists during pregnancy.

Clinic reproductive health REMEDI offers first class service. We diagnose and treat gynecological diseases We carry out operations of any complexity.

Our obstetrician-gynecologists.

Synechiae are tight connections between various organs and the appearance of connective tissue bridges between them. In gynecological practice, two types of synechiae are most often encountered: changes in the structure of the labia minora in girls and intrauterine synechiae in adults.

Synechia of the labia in young patients occurs due to a lack of the hormone estrogen at a young age, as well as due to non-compliance with personal hygiene rules: insufficient care intimate area or, on the contrary, washing too intensively using aggressive cleansers.

Adhesions of the intrauterine cavity in adult patients occur as a result of complications during childbirth, induced abortions, and various intrauterine interventions.

The main method of getting rid of unwanted connections is their dissection. Methods for dissecting synechiae in girls and defects inside the uterine cavity are fundamentally different. The need for given impact determined taking into account possible indications and contraindications.

Carrying out the procedure

Dissection of synechiae in girls is carried out by detaching tissue using a special tool in the form of a stick with a rounded top. Before performing this manipulation on the area that will be subjected to further mechanical pressure, a topical anesthetic is applied, after which the actual disconnection is carried out very quickly (within a few seconds). The wound is treated with an antiseptic, after which the mother can take her daughter home.

Removing unwanted tissue in the uterus is a more complex operation. The manipulation is performed using a special optical device - a hysteroscope, thanks to which the doctor is able not only to carry out disconnection and other necessary manipulations, but also to visually monitor each action.

Depending on complexity upcoming operation the type of anesthesia is selected - local anesthesia or intravenous administration anesthesia During the work, the doctor can additionally use various devices, for example, a Foley catheter, endoscopic forceps or scissors, or an “electronic knife”, in order to create natural channels inside the cavity and eliminate adhesions.

The thinnest films are easily cut by the body of the hysteroscope; denser ones are removed gradually using sharper instruments. Finally, when bleeding vessels are identified in the uterus, they are coagulated to stop the release of blood.

Indications for use

Elimination of existing connections is carried out if the following indications are present:

  • the presence of fusion of the labia minora in small patients, if symptoms such as the outpouring of a stream of urine to the upper side, difficulty urinating, and the appearance of vaginal discharge are observed;
  • violations reproductive function caused by the above reasons;
  • scanty menstruation (or none at all) complete absence), the cause of which is the presence of this pathology;
  • pain in the affected area, intensifying immediately before menstruation.

Principles of treatment

Separation of synechiae is carried out only after preliminary instrumental diagnostics and passing the relevant tests (ultrasound, blood test, etc.). The impact can be carried out both as a separate small operation, and while carrying out other surgical interventions(for example, removal of polyps).

Along with surgical treatment, great value V postoperative period has maintenance normal level hormones. For this purpose, it is advisable to determine the content of estrogen and other substances in the blood. If certain violations are detected, they may be assigned hormonal drugs for up to six months after surgery. If signs of inflammation are detected, antibacterial therapy is carried out.

Synechiae are acquired or congenital adhesions neighboring 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 basal layer of the endometrium of the uterus (after abortion or childbirth, uterine surgery), 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.

By 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, hormone therapy(appointed 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.