Asherman’s Syndrome

Asherman’s Syndrome

Asherman’s syndrome occurs after a dilation and curettage (D and C) procedure. It is a treatment for an incomplete miscarriage, as a means of pregnancy termination or if the placenta is retained after delivery. Asherman’s syndrome is painful and causes infertility. The risk of developing this condition increases with the number of D&C procedures.

It is vitally important to discuss the risks and complications of the D&C procedure and the risk of Asherman’s Syndrome. As a minimum the risks outlined should include: bleeding, infection, injury to uterus (and what type of injury), secondary laparoscopy/laparotomy, hysterectomy as a last resort, formation of intrauterine adhesions (Asherman’s Syndrome). Surgery is needed to cut away the adhesions. It is a cause of chronic pain and infertility is especially important for women wanting to conceive.

Failure to provide details of the risks and how they can affect the patient would fall below the expected standard of care.

These risks increase if a second surgical procedure is undertaken. It is well recognised that ultrasound scans to investigate post-partum haemorrhage have varying levels of sensitivity and specificity. The RCOG Guidelines suggest that the diagnosis of retained products by ultrasound is unreliable. Surgery is only one possible option. Treating bleeding conservatively using drugs including ergometrine, oxytocin-analogues, or tranexamic acid should be offered and discussed.