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Intrauterine synechiae treatment. Intrauterine synechiae

(Asherman's syndrome) - intrauterine adhesions leading to complete or partial obliteration of the uterine cavity. With intrauterine synechiae, hypomenstrual syndrome or amenorrhea, algodysmenorrhea, impaired reproductive function (miscarriage, infertility) are observed, and sometimes hematometra develops. Asherman's syndrome is diagnosed using ultrasound, hysteroscopy, ultrasound hysterosalpingoscopy, and hormonal tests. Treatment consists of hysteroscopic dissection of synechiae and cyclic hormone therapy. The prognosis for subsequent childbearing is determined by the severity and prevalence of intrauterine synechiae.

General information

Intrauterine synechiae are connective tissue adhesions that weld the walls of the uterus together and cause its deformation. In the presence of synechiae, the normal endometrium undergoes atrophic transformation. Intrauterine synechiae lead to disorder menstrual function, create mechanical obstacles to the advancement of sperm, worsen conditions for implantation ovum. This leads to the main manifestations of Asherman's syndrome - hypomenorrhea, secondary amenorrhea, spontaneous abortion, infertility.

Causes of formation of intrauterine synechiae

In gynecology, the development of intrauterine synechiae is associated with exposure to infectious, traumatic agents and neurovisceral factors. Most common cause Asherman's syndrome is caused by previous mechanical injuries of the basal endometrium. Injury to the endometrium can occur as a result of surgical termination of pregnancy, the use of intrauterine contraceptives, diagnostic curettage of the uterine cavity in case of uterine bleeding or endometrial polyps, operations on the uterine cavity (myomectomy, metroplasty, cervical conization). Endometrial damage may be aggravated by infection during wound phase with the development of endometritis.

Development intrauterine adhesions may contribute to genital tuberculosis, the diagnosis of which is confirmed by endometrial biopsy or bacteriological research menstrual flow. Also negative impact the endometrium is treated with intrauterine instillations and radiation therapy for tumors of the uterus and ovaries. Often the formation of intrauterine synechiae occurs against the background of a previous frozen pregnancy, since the remnants of placental tissue stimulate the activity of fibroblasts and the early formation of collagen before endometrial regeneration.

Classification of intrauterine synechiae

Based on the type of histological structure, 3 groups of intrauterine synechiae are distinguished. Film adhesions usually consist of basal endometrial cells, are easily dissected with the tip of a hysteroscope and correspond to mild form Asherman's syndrome. At medium degree intrauterine synechiae are fibromuscular, tightly fused to the endometrium, and bleed when cut. The severe form of Asherman's syndrome is characterized by dense, connective tissue intrauterine synechiae, which are difficult to dissect.

Based on the degree of involvement of the uterine cavity and the prevalence of intrauterine synechiae, 3 degrees of Asherman's syndrome are distinguished. With I degree in pathological process less than 25% of the uterine cavity is involved, the synechiae are thin and do not extend to the fundus of the uterus and the mouth of the tubes. In stage II disease, synechiae occupy from 25% to 75% of the uterine cavity, there is no adhesion of the walls, partial obliteration of the fundus and orifice is noted fallopian tubes. III degree of Asherman's syndrome corresponds to the involvement of almost the entire uterine cavity (>75%).

Symptoms of intrauterine synechiae

Depending on the severity of intrauterine synechiae, hypomenstrual syndrome or secondary amenorrhea may develop. With obliteration lower sections of the uterus, with the functional preservation of the endometrium in its upper parts, the formation of hematometra may be observed.

Significantly pronounced intrauterine adhesions with a lack of functioning endometrium prevent implantation of the fertilized egg; obliteration of the tubes makes the process of fertilization impossible. Therefore, intrauterine synechiae is often accompanied by miscarriage or infertility. In addition, even the presence of mild intrauterine synechiae often causes ineffectiveness in vitro fertilization.

Diagnosis of intrauterine synechiae

Most women with Asherman's syndrome experience menstrual and reproductive functions preceded by abortion, endometrial curettage, other intrauterine manipulations, endometritis. Data gynecological examination with intrauterine synechiae they are nonspecific.

Managing pregnancy in women with Asherman's syndrome requires the obstetrician-gynecologist to take into account all possible risks. The conditions for preventing the formation of intrauterine synechiae are the prevention of abortions, careful and reasonable conduct of intrauterine manipulations and operations, timely treatment genital infections, regular visit gynecologist.

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 twice a year. Also, one of the visible symptoms of the disease is scanty menstruation or its complete absence. Termination menstrual cycle threatens the accumulation of 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, after the procedure is completed, a special gel-like filler is injected into the woman’s uterine cavity. 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 postoperative period admission required 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!

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.

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;
  • treating wounds with an 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.