難治性のAsherman 症候群に対し、子宮鏡術後に再内腔癒着を起こすも妊娠成立し得た1 例

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  Asherman syndrome is defined by the presence of intrauterine adhesions and is a possible complication of miscarriage, uterine inflammation, myomectomy, cesarean delivery, or uterine artery embolization (UAE). It can cause menstrual disturbances, infertility, and placental abnormalities. There is no clear consensus on treatment. We report a patient with Asherman syndrome who conceived 2 years after hysteroscopic adhesiolysis.

  A 27-year-old primipara with a 7-cm myoma delivered a male infant at term, and UAE was performed for postpartum hemorrhage. Two weeks later, she experienced degeneration of the myoma and underwent hysteroscopic myomectomy with dilation and curettage. No measures were taken to prevent intrauterine adhesions. Two years postoperatively, she sought evaluation at our hospital for amenorrhea. Hysteroscopy revealed filmy stenosis of the internal os and dense adhesions involving the left side of the uterine cavity. Adhesiolysis was performed by blunt dissection, and an intrauterine device was placed to prevent further adhesion formation. Two years after the adhesiolysis, the patient conceived. She delivered a female infant by cesarean at 37 weeks of gestation. During surgery, the left intrauterine surface was noted to be macroscopically normal and adhesions were not visualized; however, placenta accreta was present.

  It is important to be aware of the risk of Asherman syndrome and to take measures to prevent intrauterine adhesions in high-risk patients. It is controversial whether cesarean or vaginal delivery is better for patients who conceive after intrauterine adhesiolysis. Our patient's course suggests that cesarean delivery might be better, as physicians can deal with unexpected placenta accreta.