Dinh Hoang The, Nguyen Nhan Trong, Tran An Nguyen Phuong
School of Medicine, Vietnam National University Ho Chi Minh City, Di An City, Binh Duong Province, Vietnam.
Department of Obstetrics and Gynecology, Pham Ngọc Thach University of Medicine, Vietnam.
Gynecol Minim Invasive Ther. 2024 Jul 18;13(3):192-195. doi: 10.4103/gmit.gmit_5_24. eCollection 2024 Jul-Sep.
Asherman's syndrome, characterized by intrauterine adhesions (IUAs), represents a significant challenge in the field of female infertility. Hysteroscopic adhesiolysis has emerged as the gold standard for both the diagnosis and treatment of Asherman's syndrome. Understanding the intricate relationship between Asherman's syndrome, uterine adhesiolysis, and infertility is crucial for guiding comprehensive and effective management strategies. The success of the treatment is contingent upon preventing adhesion recurrence, particularly in cases of severe IUAs. This is the first case, in which we employed a multifaceted preventive approach, utilizing hyaluronic gel, Foley balloon, hormonal therapy, and platelet-rich plasma, achieving successful pregnancy following embryo transfer despite the presence of severe IUAs. The patient, a 35-year-old female, underwent one cesarean section following fertilization and required dilation and curettage due to retained products of conception. The patient presented with oligohemorrhage, and the uterine lining was thin while using hormones for endometrial preparation. The diagnosis of severe IUAs was confirmed through ultrasound and hysteroscopic examination of the uterine cavity. The patient underwent hysteroscopic adhesiolysis with a preventive approach using a combination of methods. Subsequently, the patient underwent a second-look hysteroscopy to assess the uterine cavity and achieved successful embryo transfer. The patient carried the pregnancy to 38 weeks and underwent repeated cesarean section due to the vertex-vertex presentation of the twins.
阿谢曼综合征以宫腔粘连（IUAs）为特征，是女性不孕症领域的一项重大挑战。宫腔镜粘连松解术已成为阿谢曼综合征诊断和治疗的金标准。了解阿谢曼综合征、子宫粘连松解术与不孕症之间的复杂关系对于指导全面有效的管理策略至关重要。治疗的成功取决于防止粘连复发，尤其是在严重宫腔粘连的情况下。这是首例我们采用多方面预防方法的病例，使用透明质酸凝胶、Foley球囊、激素疗法和富血小板血浆，尽管存在严重宫腔粘连，但胚胎移植后仍成功妊娠。该患者为35岁女性，受精后行剖宫产1次，因妊娠物残留行刮宫术。患者出现月经量少，使用激素进行子宫内膜准备时子宫内膜薄。通过超声和宫腔镜检查宫腔确诊为严重宫腔粘连。患者采用多种方法联合的预防方法进行了宫腔镜粘连松解术。随后，患者接受了二次宫腔镜检查以评估宫腔，并成功进行了胚胎移植。患者妊娠至38周，因双胞胎头先露行再次剖宫产。
