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Asherman’s syndrome

Asherman’s syndrome

Asherman’s syndrome is a condition which occurs in women who have had several dilatation and curettage (D&C) procedures. Asherman’s Syndrome, or intrauterine adhesions/scarring or synechiae, is an acquired uterine condition, characterized by the formation of adhesions (scar tissue) inside the uterus and/or the cervix. In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus.

Symptoms of Asherman’s Syndrome

Most patients with Asherman’s Syndrome have little or absent periods (amenorrhea) but some have normal periods. Some patients with no periods feel pain at the time that their period would normally arrive each month. This pain may indicate that menstruation is occurring but the blood cannot exit the uterus because the cervix is blocked by adhesions. Recurrent miscarriage and infertility could also be symptoms and problems of the condition.

How does it occur?

Asherman’s syndrome occurs when trauma to the endometrial lining triggers the normal wound-healing process, which causes the damaged areas to fuse together. Most commonly, intrauterine adhesions occur after a dilation and curettage (D&C) that was performed because of a missed or incomplete miscarriage, retained placenta with or without haemorrhage after a delivery, or elective abortion.

Pregnancy-related D&Cs have been shown to account for 90% of Asherman’s Syndrome cases. Sometimes adhesions also occur following other pelvic surgeries such as Caesarean section, surgery to remove fibroids or polyps, or in the developing world, as a result of infections such as genital tuberculosis and schistosomiasis.

There is a 25% risk of developing Asherman’s Syndrome from a D&C that is performed 2 to 4 weeks after delivery.  Dilation and Curettages may also lead to Asherman’s Syndrome in 30.9% of procedures for missed miscarriages and 6.4% of procedures for incomplete miscarriages.

The risk of Asherman’s Syndrome increases with the number of D&Cs performed; after a single termination the risk is 16%, however, after 3 or more D&Cs, the risk increases to 32%. Each case of Asherman’s Syndrome is different, and the cause must be determined on a case-by-case basis. In some cases, Asherman’s Syndrome may have been caused by an “overly aggressive” D&C. However, this is not often considered to be the case. The placenta may have attached very deeply in the endometrium or fibrotic activity of retained products of conception could have occurred, both of which make it difficult to remove retained tissue.

If you have been diagnosed with Asherman’s Syndrome after D&C’s have been performed then call us for further advice. Our Solicitors for Women team have experience of such claims and are here to help you.

Case law

In SF v SOUTH TEES HOSPITAL NHS FOUNDATION TRUST (2010)  there was an out of court settlement awarded to the Claimant in the sum of £7,500 when she suffered with Asherman’s syndrome after the birth of her child. During the third stage of labour a registrar pulled on the umbilical cord, which snapped. The placenta was delivered in pieces. The Claimant was discharged from hospital but experienced flu-like symptoms for about a week. A month later she passed a large blood clot and underwent an ultrasound scan which showed the presence of retained products of conception.

She then underwent evacuation of retained products of conception (“ERPC”) surgically. As a result of the removal of the base layer of her endometrium, she developed Asherman’s syndrome. She was prevented from having periods and her chances of future conception were affected.

If you have also had a similar experience then contact us today to find out from our Solicitors for Women team if you can claim or email Dr Victoria Handley at vhandley@handleylaw.co.uk


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