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Prevention of Asherman's Syndrome

Since the risk of Asherman's Syndrome is high (as we presented earlier) on the recently pregnant (following miscarriage or postpartum) uterus, those who aim to prevent Asherman’s Syndrome from occurring, recommend that a D&C in the postpartum or postabortion period, should be avoided if at all possible. Of course, this treatment decision can only be made with your personal doctor, according to your individual case.

The most recent and most comprehensive paper on Asherman's Syndrome, (Yu, et al, 2008) reviews148 articles on Asherman's Syndrome. Yu presents, that since the risk of developing AS during this delicate time is so great, and since prevention is always better than treatment; D&Cs should be avoided as much as possible on the gravid uterus (19).

As we have mentioned in this site, and as Yu (2008) presents in this paper, there are other options to the blind D&C, such as expectant management, medical management and other surgerical alternatives, such as hysteroscopy (19).

An article by Goldenberg, which was also cited by Yu, researched using hysteroscopy to treat RPOCs post miscarriage and postpartum. The procedure was very short with a 10 min avg, and was found to be very effective, based upon removing RPOCs as evidenced by reduced bleeding and follow up diagnostics (20). A further study, in which Goldenberg was involved in, in 2001, compared blind D&C with hysteroscopic guided curettage for the efficacy of removing retained tissue. This study, by Cohen, et al, found that 20.8% of patients with the blind D&C needed a repeat procedure (this second procedure used hysteroscopic guidance) and that none of the patients who had initial treatment with hysteroscopically guided curettage needed a repeat procedure. Both of these studies demonstrate the benefits for the use of a hysteroscope to treat RPOCs (21).

In March’s 2006 article, he proposes a prophyllactic approach following a high risk D&C, “to prevent intrauterine scarring following a D&C performed for postpartum hemorrhage 2-4 weeks after delivery, when the uterus is most vulnerable to scarring, I would propose to the patient that she not breast-feed, that a splint be placed in her uterus, and that she receive estrogen therapy. Although there are no studies on the ifficacy of this prophylactic approach, these measures may help prevent the development of intrauterine adhesions, which are quite difficult to cure” (22).