answers

[Guest guest]

Hello Everyone

Here are the answers from my consultant. I only sent half of them to her.

1. What is the best test available to diagnose the presence of scar tissue and therefore Ashermans? I.e. Ultrasound, HSG,

hysterscopy or other?

1) Hysteroscopy - this allows to directly assess the state of the endometrium and the cavity, in order to decide the appropriate treatment in each case.

2. When the scar tissue is down to the muscle wall of the uterus, can surgery or hormone intake or even Viagra encourage the

growth of new endometrium or only increase the growth of existing endometrium? If the latter were correct, would this cause a problem during pregnancy?

2) Don't know - very little information exists on exactly how and which treatment causes re-growth- whether of new or existing endometrium.

3. It can take some doctors years to diagnose a patient with Ashermans. What immediate signs do you think any doctor

should be aware of diagnosing a patient for Ashermans?

3) The lack of regular menstruation after the uterine curettage usually alerts one, but ofcourse this doesn't hold good if periods are irregular or scanty from before the procedure eg in women with PCOS.

..4. Does having had Asherman's, or even just having a small amount of scar tissue present in the uterus, affect the estrogen

receptors in the uterus in any way, so that the endometrium does not respond to the effects of estrogen and thus does

not thicken properly, even when supplemental estrogen hormones are given? Can this be determined and/or treated?

4) Don't know !

5. Is there research being done on repairing or regenerating the endometrium with the uterus? If so what are they?

5) As above

6. Is it dangerous to leave Asherman's untreated, if someone is not intending to get pregnant? For example, if one gets a

menstrual flow and is not being passed through the cervix because it is closed shut from scarring, could this blood leak

backwards and out through the fallopian tubes and in time cause endometriosis?

6) No it isn't dangerous provided most or all of the endometrium is destroyed. In fact this is created surgically in women who have heavy periods but wish to avoid hysterectomy - the operation is called endometrial ablation / resection. However, you are correct in assuming that if there is sufficient residual endometrium for menstrual build up without an outflow tract, endometriosis could result.

7. When a patient is admitted to hospital with retained placenta and an infection, is it better to treat the infection first and then

remove placenta or the other way round? Or does this not make any difference?

7) Unless there is gross sepsis treatment usually proceeds simultaneously with antibiotics and uterine curettage. If the patient has signs of sepsis IV antibiotics are given for 24-36hrs before curettage. It is important to empty the uterus asap as the focus of infection is the retained placental tissue ( which often is no more than a few fragments ).

8. Can further D & C’s or surgeries to an Ashermans sufferer worsen their situation? E.g. after a miscarriage, fibroids etc,

attempt at removal of further adhesions?

8) Only further curettage/ resection of the endometrium can worsen the condition. Simply releasing synechiae will not - infact this is treatment for AS as it restores the cavity.

9. Once Ashermans is treated, what would you consider the minimum " safe’ endometrium thickness for a successful pregnancy?

9) Between 6-16m would be considered normal -obviously the thicker the better- but it is not simply a matter of thickness, there are several other factors, many as yet unknown, that play a part.

10. What procedures and precautions do you believe a doctor should do to avoid Ashermans? Such as: Using too sharp of an

instrument during a D & C? Doing an ultrasound at 1-2 weeks after a complicated delivery or premature delivery? Etc....

10) This is a tricky one to answer ! A surgeon may have performed umpteen similar procedures using the same technique without any problems, and then suddenly finds he/she has a case of AS. The usual advice is to avoid " too vigorous " curettage - but this is a difficult concept to quantify as there is a fine balance between getting the uterus thoroughly emptied of retained tissue (to prevent infection and bleeding) and avoiding over-curettage.

11. Apart from getting the endometrium to thicken, which other factors play a vital role in maintaining a pregnancy to full term

in Ashermans cases?

11) Don't know - again so little is known about the normal implantation process that it would pure speculation if I was to give you a view on AS.

[Guest guest]

Thanks for sharing!!!

~Jen