Intrauterine synechia. Synechia in the uterine cavity: what is it and how to get rid of it? Intrauterine synechia symptoms

Various pathological processes in the organs, even after their complete cure, can leave some complications and consequences. It is these unpleasant complications of inflammatory (most often) processes that include synechia, which can form in the uterine cavity. About what it is, and how they affect the quality of life and reproductive function, is described in this material.

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Definition

What is synechia in the uterine cavity? Synechia is the medical name for adhesions, which are neoplasms of inextensible connective tissue that are formed as a result of inflammatory processes and are able to tighten organs, deform them, block their lumen, etc.

You can often hear that in the context of this topic, such a diagnosis as Asherman's Syndrome is mentioned. What it is? This is a disease that occurs only in women and is an adhesive process (the presence of synechia in the uterus).

Structure

Causes

Most often, this condition develops as complications after pathological and even medical processes. Among them:

Inflammatory processes;
infectious processes;
Processes with the formation of exudate;
Surgical interventions, cleanings, abortions (if we are talking about the uterus, etc.).

From a technical point of view, the process of formation of adhesions is associated with the fact that the tissue affected during the pathological process or surgical intervention begins to be replaced by another. In such processes, fibrous connective tissue is always formed (it also forms, for example, scars and scars), which does not have any functions.

Classification

This pathological process can be classified in different ways. There are several types of classifications depending on the tissue composition of synechiae, their location, and the degree of development of the process. Such a system of classifications allows doctors to better navigate the process, and is also important for determining the optimal method of treatment.

Histology

There are three types of synechia according to tissue composition. They correspond to the three stages of the syndrome.

The mild stage is characterized by the presence of adhesions from the epithelial tissue. They are thin and easily dissected;
The middle stage is characterized by the presence of more dense, fibromuscular neoplasms, densely germinated to the endometrium. They are more difficult to dissect, they bleed when damaged;
The severe stage is distinguished when the synechiae are dense, consist of connective tissue and are difficult to dissect.

In principle, any stage can be cured surgically, but the volume and complexity of the intervention will be different.

By prevalence

In this case, we are talking about how much of the cavity is involved in the process.

The first type is characterized by the involvement of up to 25% of the uterine cavity, the orifices of the tubes are not affected;
The second type is distinguished when from 25 to 75% of the cavity is involved, the mouths are slightly affected, there is no adhesion of the walls;
The third type - more than 75% of the cavity is involved, the mouths are affected, there may be sticking of the walls and deformation of the organ.

From the point of view of pregnancy, any type of pathology is undesirable, however, with the third type, conception is also very unlikely.

According to the degree of damage and closure of cavities and gaps

This is an international classification used by the Association of Gynecologists-Endoscopists. According to her, 6 stages of the syndrome are distinguished.

I - thin films that are destroyed upon contact with the hysteroscope;
II - denser films, often single;
II-a - localization inside the uterine os, when the upper sections are not affected;
III - dense multiple areas, mouths are affected;
IV - signs of the third stage are supplemented by partial occlusion of the cavity;
V - signs of all other stages, as well as the presence of scars on the walls.

This classification is used only in the context of surgery.

Symptoms

Signs that synechia has formed in the uterus may be different. But most often it is a stable pain syndrome, which occurs mainly during physical exertion or placing the body in a certain position. In addition, this is possible with a full bladder and during menstruation. The pains are sharp and sharp, of high intensity, or aching. Usually, they increase with physical inactivity - in this case, they can begin to appear even at rest.

Depending on the location of the formations, there may be problems with conception, up to infertility, urination disorders. Possible violation of the outflow of menstrual blood /. Violation of defecation, etc.

Diagnostics

Synechiae have a density different from other uterine tissues, therefore they are easily visualized during ultrasound examination. During the ultrasound, it is possible to determine both the actual location of their location, and the degree of closeness of the organ by them, how deformed it is, etc.

If it is necessary for diagnostic purposes to take tissues of synechia for histology, then this is done during hysteroscopy. The same method can also be used to examine the uterine cavity for diagnostic purposes (if there are no obstacles to the penetration of equipment into its cavity).

Impact on pregnancy

Synechia in the uterine cavity is a serious problem during pregnancy. This is due to the fact that these inextensible ties actually fix the organ in a static state. Thus, the walls of the uterus are at a fixed distance from each other. As the fetus grows, the organ enlarges and stretches, with adhesions this leads to severe pain, hypertonicity of the organ, and as a result, miscarriage or abortion for medical reasons. If such a recommendation is neglected, then theoretically even a rupture of the organ can occur.

In addition, adhesions can be placed in such a way that they deform the fetus, allow it to grow, and put pressure on it. The resolution of pregnancy in this case will be the same as described above. Although most often in the presence of adhesions, the onset of pregnancy is difficult. If they are present in the uterus, then the fetus is poorly attached, and if it is attached, then miscarriages occur in the early stages. But more often there are problems even at the stage of conception - the cervical canal or fallopian tubes can be closed by adhesions.

However, after the removal of synechia, pregnancy can be planned. Usually, depending on the individual characteristics of the body and the volume of the operation, the doctor recommends starting attempts at conception already six months to a year after removal.

Therapy

Treatment of this condition is carried out in several ways and, most often, in a complex way, that is, several of them are used at once. All methods can be divided into two large groups - radical and conservative. Much in the choice of treatment depends on where the adhesions are located, how thick they are, and what histological composition they have.

conservative

The following conservative methods of influence are most often used:

Gynecological massage. The method is especially good for thin adhesions, which have minimal elasticity and are small in size. During the massage, they are mechanically stretched, as a result of which the organ and / or its parts return to their normal physiological positions, the organ lumens open. That is, in fact, the spike remains in place, but no longer causes discomfort. The method is not suitable for those who are going to give birth in the future, and is also ineffective when adhesions are located in the mouths of the fallopian tubes, cervical canal, etc .;
Physiotherapy by methods of microwave and / or UHF exposure is indicated in the same cases as gynecological massage. Often these two methods are used together. Exposure to microwaves leads to the fact that small adhesions dissolve, those that are larger become more elastic and stretch more during the massage. The method is used as an additional method for both radical and conservative treatment;
Therapeutic gymnastics is a special set of physical exercises that is developed by a physiotherapist and is aimed at gradually stretching small adhesions so that they no longer cause discomfort. That is, this method, according to the principle of action, is similar to gynecological massage. In addition, it has the same indications, contraindications and scope. Most often, physiotherapy, gymnastics and massage are prescribed together with a slight degree of development of the pathology.

All methods of conservative therapy are used in combination with a mild severity of the process. They are not suitable for those who are planning a pregnancy after the removal of synechiae in the uterus, since they do not actually remove adhesions, but only make them so that they do not cause discomfort for a given organ size. But with an increase in the uterus, they will again make themselves felt. An exception can be called physiotherapy - in rare cases, this method contributes to the complete resorption of small adhesions, but often its effectiveness is not enough to completely cure.

Radical

The radical method of treatment involves surgical intervention. It involves the introduction of a scalpel into the uterus and direct dissection of the adhesions. In some cases, their complete removal is also necessary. Such an intervention may have a different level of severity depending on which method it was performed, and the choice of method, in turn, depends on the structural features of the uterus, the location of adhesions in it, their size, etc.

Such an intervention is almost never performed laparotomically, since in most cases it is pointless, because as a result of such an operation, new adhesions can form. Sometimes it is performed laparoscopically, when micro-instruments and a camera are inserted through punctures in the abdominal wall and the wall of the uterus with a diameter of 1.5 cm, and with the help of them, an operation is performed on the image from the camera that appears on the screen.

The least traumatic and most desirable method is hysteroscopic incision, during which the hysteroscope tube is inserted into the uterine cavity through the cervical canal. Instruments and a camera are inserted through the tube and an intervention is performed. While this method is preferred, it may not be suitable for all adhesion locations.

Such a dissection of synechia in the uterus is usually supplemented by a course of physiotherapy. Also, therapeutic exercises and gynecological massage can be used during the recovery period and after it. This is done in order to prevent the formation of new, postoperative adhesions, and to stimulate the resorption of those small ones that could remain after the operation.

Effects

What happens if treatment is not carried out? The following consequences are possible:

Persistent pain syndrome;
Violation of the work of organs and systems located nearby;
Deformation of the organ;
His injuries and injuries;
Synechia in the uterus during pregnancy leads to miscarriage or abortion for medical reasons;
Infertility.

Not all adhesions lead to such problems, however, if there are indications for removal, then they cannot be neglected even if the patient does not plan to have children.

Conclusion

Synechia of the uterus is a serious enough problem, and this is a condition that requires treatment. Therefore, it is advisable to consult a doctor in a timely manner if you detect symptoms of its presence.

With normal sexual development of the 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 distinction between the labia minora and the large ones and the genital gap is visible, which allows you to freely examine the vagina.

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

With the development of violations, the fusion of the labia occurs, and in more complex cases, the connection of small and large lips. Fusion can occur from the first days of a child's life or in the process of 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 synechia can be asymptomatic, which makes their diagnosis difficult 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 upwards, not downwards;
the girl feels discomfort (constantly fidgets on the potty, complains of pain, cries, pushes);
redness of the genitals and the appearance of a rash, itching;
washing away causes pain, the child constantly cries;
dilution of the labia causes pain, while only part of the vagina is visible.

Why do synechias occur

Experts identify the following factors that provoke lip fusion:

Violation of hygiene rules. Frequent washing with soap can break the vulvar mucosa, contribute to the formation of microcracks and wounds. Insufficient washing contributes to the development of pathogenic organisms.
Infectious diseases. A child can become infected with a sexually transmitted infection during childbirth, when using a common washcloth or towel, when swimming in a natural reservoir.
Allergic reaction. Allergies can affect not only the skin of the child, but also the mucous membranes. In this case, food allergens are most often the cause of the fusion of the genital organs. The disease can develop as an allergic reaction to diapers, washing powder, soap and other products.
Hormonal disruptions. The disease develops with a lack of the hormone estrogen.
Pregnancy with intrauterine infection.
Wrong choice of underwear and diapers. When rubbing the genitals, microcracks are formed that contribute to the fusion of the lips. Overheating of the child causes diaper rash, which negatively affects the genitals.

Diagnosis of synechia of the labia

Only a doctor can establish a diagnosis - synechia of the labia, after a visual examination and a number of medical studies. Self-diagnosis and treatment of the disease can lead to a deterioration in the child's condition.

To make an accurate diagnosis, you need:

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 identification of bacterial causes of inflammation;
tests for urogenital diseases (chlamydia, mycoplasmosis and others);
blood and urine analysis;
checking blood for sugar;
check for invasive diseases (detection of worms and dysbacteriosis);
in the presence of congenital anomalies, an ultrasound examination of the pelvic organs is performed.

How is the dissection of synechia performed?

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

the use of special ointments;
dilution of adhesions of the lips.

With the timely detection of the process of fusion of the small lips, hormonal ointments are used, which contain estrogen in their composition, dissolve the formed film and promote separation. The basis of drug treatment is the application of ointments to the perineum for 3-4 weeks.

If synechia does not cause discomfort and does not harm health, then the doctor can apply expectant tactics 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 synechia is an extreme measure in treatment and is taken only in case of violation of the urination process or the absence of the effect of 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;
treatment of the genital organs with an anesthetic;
removal of the film with a scalpel within a few seconds;
treatment of wounds with an antiseptic;
rehabilitation period (treatment of wounds with a special cream, taking antibiotics in the form of an ointment, sitz baths).

Surgical intervention to remove adhesions of the genital organs in young children may be accompanied by psychological trauma (due to severe pain after surgery), the occurrence of relapses of the disease.

It is worth remembering that successful treatment does not guarantee the absence of accretion in the future. It is necessary to carry out constant monitoring of health, since up to 8 years 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 synechia are found in a variety of lengths and densities. 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 infection. 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 synechia is diagnosed in almost every second.

Causes of the disease

Currently, infectious, traumatic and neurovisceral causes of intrauterine synechia are distinguished. One of the main factors is the previous traumatization of the basal layer of the endometrium. This occurs, as a rule, due to 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", adhesions are formed.

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 bacteriological examination or endometrial biopsy. It should be borne in mind that intrauterine instillations, radiotherapy for tumors of the uterus or ovaries can be an unfavorable factor that increases the risk of developing the disease.

Symptoms of the disease

There are different degrees of severity of the disease.

In mild cases, the disease may be asymptomatic. However, later, depending on the degree of spread, the symptoms of intrauterine synechia become more diverse. The patient has pain in the lower abdomen, the intensity of which increases on critical days. At the same time, the duration of menstruation decreases, they become scarce, in severe cases, amenorrhea develops (absence of menstruation in women of childbearing age). Infection of the lower section in the uterus with a normally functioning endometrium in the upper part leads to a violation of the outflow of blood, as a result of which a hematometer may develop. The clinic at the same time resembles a picture of an acute abdomen, in this situation the patient needs emergency surgical care.

With extensive lesions in the uterine cavity with insufficiently functioning endometrium, difficulties arise in the implantation of the fetal egg. By the way, one of the reasons for the ineffectiveness of IVF - in vitro fertilization - are even mild adhesions. It should be borne in mind that intrauterine synechia is often accompanied by endometriosis (adenomyosis), which negatively affects the prognosis of treatment.

Often, patients experience symptoms of intoxication, manifested by weakness, muscle pain, heart palpitations, and emotional instability.

Classification

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

Complications

As a result of the lack of a functioning endometrium, as well as the resulting adhesions, the fetal egg cannot attach to the wall of the uterus. In addition, the fertilization process itself can be disrupted due to overgrowth of the fallopian tubes. In 30% of patients with diagnosed synechia, spontaneous abortion occurs, and in 30% of women, premature birth occurs. Often there are pathologies of the placenta. Thus, the complications of intrauterine synechia are very numerous, and pregnancy in such women is associated with a high risk. But, in addition to miscarriage, there is a possibility of postpartum hemorrhage.

Diagnostics

Currently, there is no unified survey algorithm. However, according to most doctors, the diagnosis of intrauterine synechia should begin with hysteroscopy; in case of a doubtful result, hystersalpingography is recommended.

Hysteroscopy - examination of the inner surface of the uterus using endoscopic equipment (hysteroscope). The technique allows you to perform not only a visual examination of the cavity and detect pathological changes, but also to conduct, if necessary, a biopsy or surgical intervention. This minimally invasive procedure is virtually painless and less traumatic and can be done under local or general anesthesia. The likelihood of complications after hysteroscopy is minimal.
Hysterosalpingography - in some cases more effective than hysteroscopy. With dense, multiple synechia, dividing the uterine cavity into chambers of various sizes, and interconnected by ducts, it is this study that is more informative. However, deformation of the uterine cavity, the presence of mucus and fragments of the endometrium, 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 adhesions 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 a possible pathology.
Negative hormonal tests - when prescribing progesterone and estrogen, there is no menstrual bleeding.

Treatment of intrauterine synechia

The goal of therapy is the elimination of adhesions in the uterus, the restoration of menstrual and reproductive functions. It must be emphasized that it is possible to decide how to treat intrauterine synechia only after a thorough examination. Today, the only method of treatment is the dissection of synechiae. The nature of the operation depends on the type of adhesions, as well as on the degree of damage. Weak synechiae are dissected with endoscopic forceps, scissors, or the hysteroscope body, and 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 the operation, hormone therapy is indicated, the task of which is to restore the endometrium. In the event that intrauterine synechia arose as a result of an infection, then after a biopsy and bacteriological examination, antibacterial drugs are prescribed.

Mild to moderate disease responds well to treatment. 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 a few simple rules:

Use of competent methods of contraception to prevent abortions
Intrauterine manipulations are best done in clinics with modern equipment and qualified specialists.
Timely treatment of urinary tract infections

It should be borne in mind that in some patients after the treatment there is a risk of relapse, especially with dense widespread adhesions, as well as with tuberculous lesions. Therefore, the prevention of intrauterine synechia 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 be aware of the existing risk in women with a complicated postpartum period or after an abortion. If placental remnants are suspected, if the menstrual cycle is disturbed, etc., hysteroscopy should be performed immediately, the purpose of which is to clarify the exact localization of the pathology focus and remove it without injuring the normal endometrium.

Expert advice

Gynecology

Types of services provided

Synechia are dense connections between various organs and the appearance of connective tissue bridges between them. In gynecological practice, two types of synechia are most common: changes in the structure of the labia minora in girls and intrauterine synechia 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 the rules of personal hygiene: insufficient care for the intimate area or, on the contrary, too intensive washing using aggressive cleansers.

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

The main method of getting rid of unwanted joints is their dissection. The methods of dissection of synechia in girls and defects inside the uterine cavity are fundamentally different from each other. The need for this impact is determined taking into account possible indications and contraindications.

Carrying out the procedure

The dissection of synechia in girls is carried out by detaching the tissues using a special tool in the form of a stick with a rounded top. Before performing this manipulation, an external anesthetic is applied to the area that will be subjected to further mechanical pressure, after which the actual disengagement 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.

Elimination of unwanted tissues in the uterus is a more complex action. Manipulation is performed using a special optical device - a hysteroscope, thanks to which the doctor has the opportunity not only to carry out disconnection and other necessary manipulations, but also to visually control each action.

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

The thinnest films are easily dissected by the body of the hysteroscope, the denser ones are removed gradually with the help of sharper instruments. Finally, when bleeding vessels are detected in the uterus, they are coagulated to stop the bleeding.

Indications for appointment

Elimination of existing connections is carried out in the presence of the following indications:

the presence of fusion of the labia minora in small patients, if symptoms such as the outflow of a stream of urine into the upper side, difficulty urinating, the appearance of vaginal discharge are observed;
reproductive disorders caused by exposure to the above reason;
meager menstruation (or their complete absence), the cause of which is the presence of this pathology;
pain in the affected area, aggravated immediately before menstruation.

Principles of treatment

Separation of synechia 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 with the simultaneous implementation of other surgical interventions (for example, removal of polyps).

Along with surgical treatment, maintenance of normal hormone levels is of great importance in the postoperative period. For this purpose, it is desirable to determine the content of estrogen and other substances in the blood. If certain disorders are identified, hormonal drugs can be prescribed for up to six months after surgery. If signs of inflammation are detected, antibiotic therapy is performed.

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

Causes of synechia

To date, several theories of the formation of intrauterine synechia are known: traumatic, infectious and neurovisceral. According to the traumatic theory, the key trigger that triggers the process of synechia is traumatic damage to the basal layer of the endometrium. Mechanical trauma is possible due to difficult childbirth or frequent curettage of the uterine cavity, as well as abortions. In this case, the infection is a secondary factor in the occurrence of uterine synechia. Also, synechia of the uterine cavity can form in women whose gynecological history is aggravated by a missed pregnancy. This is possible because the remaining tissue of the placenta can 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 synechia, which are formed 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. Synechia is often observed after conization of the cervix or severe endometritis. Frequent provoking factors for the formation of synechia 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 synechia

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

I degree is characterized by the involvement of no more than 1/4 of the volume of the uterine cavity in the pathological process, intrauterine adhesions of a thin diameter, and the bottom of the uterus and the mouth of the fallopian tubes are free.
II degree - intrauterine synechia extend to at least 1/4 and not 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 overlap the bottom of the uterus and the mouth of the fallopian tubes.
III degree is characterized by the involvement in the pathological process of more than 3/4 of the volume of the entire uterine cavity.

Clinical manifestations of intrauterine synechia

The clinic of synechias located inside the uterine cavity depends on the extent of the lesion by the pathological process of the uterine cavity. The most common clinical manifestations of intrauterine synechia are amenorrhea or hypomenstrual syndrome. The result of a long and neglected process of being inside the uterine cavity is infertility, or the inability to bear a child. In those cases when there is an infection of the lower sections of the uterus with a normally functioning internal endometrium in the upper sections, a cavity filled with blood (hematometra) may form. With a significant infection of the uterine cavity and a poorly functioning inner layer of the uterus, it makes it difficult for the embryo to implant into the uterine cavity. Also, intrauterine synechia of even a small diameter can cause ineffective in vitro fertilization.

Diagnosis of intrauterine synechia

To remove synechia, it is necessary to clearly establish their localization and the degree of damage to the uterine cavity by synechia. For the diagnosis of synechia, the following research methods are used:

Hysterosalpingography;
Ultrasound examination of the pelvic organs;
Hydrosonography;
Diagnostic hysteroscopy.

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

Diagnostic hysteroscopy

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

Hysterosalpingography

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

Ultrasound examination of the pelvis

At present, even advanced ultrasound equipment, when detecting intrauterine synechia, 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 some cases, it is possible to visualize the fuzzy contours of the inner layer of the uterus, and in the presence of a hematometer, an anechoic formation is detected that completely fills the uterine cavity. With hydrosonography, single synechia of the uterine cavity can be determined when there is no complete obstruction in the lower segment of the uterus. Dense intrauterine synechia are characterized as white strands of dense consistency, which are localized more often along the side walls. In the central part of the uterus, they are located very rarely. A large number of transverse synechia lead to partial or complete infection of the uterine cavity in the form of numerous cavities of different sizes. These cavities are sometimes mistaken for the mouths of the fallopian tubes.

Treatment of intrauterine synechia

Today, the only correct solution for the treatment of synechia of the uterine cavity is the dissection of synechia 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 the reproductive function of a woman. The volume of operations for the separation of synechia and its effectiveness depends on the type of synechia and the degree of obstruction of the uterine cavity by synechia.

Intrauterine synechia, which are localized in the central part of the uterus, can only be dissected in a blunt way, using the body of the hysteroscope. Also, special endoscopic scissors and forceps are used to separate synechiae. At the same time, a hysteroresectoscope with an electrode (“electroknife”) is used to completely dissect the synechiae of the uterine cavity.

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

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

Prognosis for synechia inside the uterine cavity

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

Women who underwent surgical treatment of synechia in history during pregnancy are at risk for the occurrence of complications during pregnancy, delivery and the course of the early postpartum period. In 35% of pregnant women who have synechia inside the uterine cavity, spontaneous abortion is observed. 30% go into labor prematurely, while the remaining 35% of pregnant women develop placental pathology (tight or partial attachment of the placenta or placenta previa).

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