The book covers the entire aspect of intrauterine adhesions and Asherman's syndrome highlighting important points. It discusses etiopathogenesis to diagnosis and the current guidelines with effective treatment policies. It covers new treatment techniques, use of stem cell therapy and various scenarios with the best management of them. The book also covers pregnancy and associated complications. It takes into account the vast clinical experience of the authors all over the world clubbed with the academic evidence available to date.
The book is relevant for endoscopic surgeons, hysteroscopists, infertility specialists and obstetricians at large, and anyone who wishes to know more about this subject.
Author(s): Rahul Manchanda
Publisher: Springer Singapore
Year: 2021
Language: English
Pages: 207
City: Singapore
Foreword
Foreword
Foreword
Preface
Acknowledgments
Contents
About the Editor
1: History and Epidemiology
1.1 History
1.1.1 Synonymous Are
1.2 Epidemiology
1.2.1 Pathology
1.2.2 Some Minutes
References
2: Etiopathogenesis of Asherman’s Syndrome
2.1 Etiology
2.2 Pathogenesis
References
3: Clinical Features (Signs and Symptoms)
3.1 Clinicopathological Association
3.1.1 Subcategories
3.2 WHRIA’s (Women’s Health & Research Institute of Australia) Stages of Asherman’s Syndrome
3.2.1 Stage I
3.2.2 Stage II
3.2.3 Stage III
3.2.4 Stage IV
3.3 Spectrum of Clinical Features
3.3.1 Gynecological Features (Fig. 3.1)
3.3.1.1 Menstrual Disorders
3.3.1.2 Infertility
3.3.1.3 Recurrent Pregnancy Loss
3.3.1.4 Causes for Recurrent Pregnancy Loss
3.4 Obstetrical Problems (Fig. 3.2)
3.4.1 Fetal Growth Restriction (FGR) and Low Birth Weight
3.4.2 Abnormal Placentation
3.4.3 Ectopic Pregnancy
3.4.4 Differential Diagnosis
References
4: Intrauterine Adhesions: Classification Systems
4.1 Background
4.2 HSG-Based Classification
4.3 Hysteroscopy-Based Classification
4.4 Clinico-Hysteroscopic Classification
4.5 Recent Updates
4.5.1 Guidelines for Classification of Intrauterine Adhesions
4.6 Conclusion
References
5: Diagnosis: Patient Evaluation (Flowchart)
5.1 Introduction
5.1.1 Clinical Suspicion
5.1.2 Ultrasonography
5.1.3 Hysteroscopy
5.1.4 Other Diagnostic Techniques
References
6: Ultrasound Diagnosis and Management
6.1 Synonyms for IUAs
6.2 Etiology of IUAs
6.3 Classification of IUAs
6.4 Pathologic Basis of Symptoms and Imaging
6.5 Diagnostic Options in Perspective
6.6 An Illustrated Guide to Imaging of IUAs
References
7: Role of Hysterosalpingography (HSG) and Sono-HSG
7.1 Introduction
7.2 Hysterosalpingography (HSG)
7.3 Patient Selection
7.3.1 Indications and Contraindications
7.3.2 Preparation
7.3.3 Procedural Technique
7.4 Radiological Contrast Used in HSG
7.5 Complications
7.6 Image Acquisition
7.6.1 Standard Set of Images (Fig. 7.6a–d) Include
7.6.2 Equipment Specifications
7.7 Radiation Dosage and Safety
7.8 Normal Appearances and Imaging Pitfalls in HSG
7.9 Role of HSG
7.9.1 Presence of Abnormal Endometrial Filling Defects (Fig. 7.10)
7.9.2 Altered Uterine Shape and Contour
7.10 Role of HSG in Tubal and Peritoneal Evaluation
7.10.1 Therapeutic Procedures During HSG
7.10.2 Reporting Format for Hysterosalpingography
7.10.3 Sono-Hysterosalpingography (Sono-HSG)
7.10.4 Technique
7.10.5 Precautions and Complications
7.10.6 Image Interpretation
7.11 Hysterosalpingo-Contrast Sonography (HyCoSy)
7.11.1 Advantages Over Conventional HSG
7.11.2 MRI and MR-HSG
7.11.3 CT-HSG
7.12 Clinical Recommendations
References
8: Diagnostic Hysteroscopy
8.1 Vaginoscopic Office Hysteroscopy Includes Following Points, Fig. 8.1
8.1.1 Advantages of Vaginoscopy
8.2 Recommendations for Analgesics: Diagnostic Office Hysteroscopy
8.3 Recommendations for Analgesics: Operative Office Hysteroscopy
8.3.1 Anticipated Cervical Stenosis
8.3.1.1 Medical Methods
References
9: Overview and Treatment: Hysteroscopic Techniques
9.1 Overview
9.2 Epidemiology
9.3 Etiology and Pathophysiology
9.4 Clinical Presentation
9.5 Workup
9.6 Classification System
9.7 Treatment
9.7.1 Hysteroscopic Adhesiolysis
9.7.2 Office Hysteroscopy
9.8 Postoperative Management
9.8.1 Solid Barriers
9.8.2 Semisolid Barriers
9.8.3 Hormone Therapy
9.8.4 Antibiotics
9.8.5 Stem Cells
9.9 Prognosis
References
10: Role of Assisted Operative Hysteroscopy in Asherman’s Management
10.1 Introduction
10.1.1 Pathophysiology
10.1.2 Management
10.1.3 Aims of Hysteroscopy
10.1.4 Technique of Hysteroscopic Adhesiolysis
10.1.5 Important Differences Between Hysteroscopic Scissors and Electrocautery
10.2 Role of Assisted Adhesiolysis
10.3 Preoperative USG Assessment of Myometrial Thickness: To Guide the Amount of Adhesiolysis
10.4 Intraoperative Transabdominal Ultrasonographic Guided Adhesiolysis
10.4.1 Advantages
10.5 Laparoscopic Guided Adhesiolysis
10.6 Laparoscopic Guided Conversion of a “Blind” Hysteroscopic Procedure to a “Septum” Division
10.7 Use of Laminaria Tent and Laparoscopic Guided Resectoscopic Adhesiolysis
10.8 Fluoroscopy-Guided Adhesiolysis
10.8.1 Advantages
10.8.2 Disadvantages
10.8.3 Technique
10.9 Gynecoradiologic Uterine Resection (GUR)
10.10 Pressure Lavage Under Guidance (PLUG)
10.11 Ultrasound-Guided Technique for Hysteroscopic Adhesiolysis Using Balloon-Aided Dilatation or Seldinger Technique
10.12 Prevention of Adhesion Reformation
10.13 AAGL and ESGE Practice Guidelines, 2017 [16]
References
11: Postoperative Care (Hormonal Therapy, Physical Barriers, Vasodilators, Antibiotics)
11.1 Intrauterine Devices (Fig. 11.5a–f)
11.1.1 Barrier Gels
11.1.2 Human Amniotic Membrane Grafting
11.1.3 Vasodilators
11.1.4 Antibiotics
11.1.5 Hormonal Therapy
11.2 Guidelines for Secondary Prevention of Intrauterine Adhesions: AAGL/ESGE 2017 [45]
References
12: Organic Tissue Grafts Following Intrauterine Adhesiolysis
12.1 Stem Cells
12.2 Different Procedures for Obtaining and Using the Stem Cells
12.3 Evidences
12.3.1 Procedure
12.3.1.1 Preparation of Hematopoietic Stem Cell
12.3.1.2 Harvested MNC Evaluated for
12.3.2 Post-procedure Care
12.3.3 Procedure
12.3.4 Delivery of BMDSCs After Successful CD133+ Isolation
12.3.5 Procedure
12.3.6 Stem Cells in Short
12.4 Platelet-Rich Plasma
12.5 Evidences
12.6 Amniotic Membrane
12.6.1 Mechanism of Action
12.6.2 Procedure
References
13: Follow-Up and Relook Hysteroscopy
13.1 Follow-Up Modalities
13.2 AAGL/ESGE 2017: Guideline for Postoperative Assessment After Treatment of Intrauterine Adhesions
References
14: Complications and Fertility Potential Following Adhesiolysis
14.1 Introduction
14.1.1 Complications Following Adhesiolysis
14.1.2 Fertility Potential Following Adhesiolysis
14.2 Conclusion
References
15: Pregnancy and Its Management: Post-Asherman’s Treatment
15.1 Important Considerations
15.2 Conception and Live Birth Rate
15.3 Obstetric Complications
15.4 Pregnancy: Stepwise Management
15.5 Preconception Management: Follow-Up Visit—After 8 Weeks of Index Surgery
15.6 Pregnancy and Its Management: Maternal and Fetal Surveillance
15.6.1 Diagnosis of Fetal Growth Restriction (FGR) or Small-for-Gestational-Age (SGA) Fetus
15.7 Evidences
15.8 Management
References
16: Placental Complications Associated with Asherman’s Syndrome
16.1 Placenta Accreta
16.2 Placenta Previa
16.2.1 Recommendations for Management of PA (American College of Obstetricians and Gynecologists, 2018) [38]
References
