Asherman's syndrome can be diagnosed by all except:
Ans. is c, i.e. Endometrial cultureRef: Williams Gynae 1st/ed, p420; Leon Speroff 7th/ed, p419Asherman's syndrome:* It is an acquired uterine defect characterized by the presence of uterine synechiaes and subsequent destruction of the lining endometrium.* M/C cause for asherman syndrome -Postpartum curettage* 2nd M/C cause - curettage done for MTP* Other causes - uterine surgery like cesarean section, myomectomy, Sheehan's syndrome* Infectious causes - TB, Schistosomiasis* Most characteristic symptom = Hypomenorrhea (scanty bleeding <20ml or <2 days) or 2deg amenorrhea* Others - Infertility* Abortion* Diagnosis: ... Williams Gynae 1st/ed, p420-l* When Asherman syndrome is suspected, HSG is indicated. Intrauterine adhesions, characteristically appear as irregular, angulated filling defects within the uterine cavity.* At times, uterine polyps, leiomyomas, air bubbles and blood clots may masquerade as adhesions.* Transvaginal USG or saline infusion sonography may help clarify these difficult cases.* A definitive diagnosis requires hysteroscopy. (Investigation of choice)Treatment:* Adhesiolysis via hysteroscopy.* Placement of an intrauterine device or Pediatric foley's catheter with the bulb filled with 3ml of fluid, to avoid contact between the ends of the adhesions.* Treatment with estrogen to stimulate endometrial growth. (Since estrogen alone can lead to endometrial, cancer. Estrogen and progesterone should be given together).Prognosis:* Approximately 70-80% of patients with this condition have achieved successful pregnancy. But pregnancy can be complicated by premature labor, placenta accreta, placenta previa and/or PPH.* Recurrence rate is high.
Hysterosalpingography
Saline sonography
Endometrial culture
Hysteroscopy
Gynaecological Diagnosis