Likely Causes of Uterine Adhesion
Synechiae results from trauma to the uterine mucosa that destroys the basal layer of the uterus. Thus, An adhesion is consisting of a simple mucosal flange, easily lifted by the hysteroscope during diagnostic hysteroscopy. If untreated, this loose flange becomes fibrous, tough, thicker or thinner, and then muscular. Then the endometrium is no longer present. A uterus loses its endometrium if synechiae persist
Risk Factors for Synechia
The following may cause synechia:
Curettage or aspiration for spontaneous abortion or elective termination of pregnancy, postpartum o, r postpartum curettage.
Retention of a terminated pregnancy, placental retention after delivery, or after the termination of pregnancy.
Operative hysteroscopy with fibroid resection, polyp resection, uterine malformation cure, endarterectomy, cervical dilation aspiration.
Myomectomy, conization.
Marked atrophy of endometrium due to menopausal hormone deficiency.
Uterine infection, endometritis, genital tuberculosis, IUD infection.
Post pelvic radiation therapy for cancer.
Some factors contribute to the development of uterine synechia after endometrial trauma:
softened uterus: this occurs during advanced pregnancy; retention of a dead egg; postpartum (after delivery).
uterine evacuation technique with an increased risk when using a suction cannula, foam curette, or windowed curette, respectively.
the occurrence of infection after uterine evacuation.
having two overlying areas of injury to the endometrium, which promotes healing as a “fibrous bridge” by direct contact
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