Prevention and treatment of severe uterine adhesions

  I. The common reasons for the occurrence of cavity adhesions are: 1. History of uterine operations such as early pregnancy negative pressure aspiration, middle pregnancy forceps scraping, middle pregnancy induction scraping, postpartum bleeding scraping and spontaneous abortion scraping. In particular, repeated scraping is very likely to damage the basal layer, and uterine adhesions caused by this cause are most common. Secondly, myoma enucleation (into the uterine cavity), submucosal myoma removal via the uterine cavity, longitudinal hysterectomy, and double hysterectomy destroy the basal layer of the endometrium and expose the myometrium to the uterine cavity, resulting in anterior and posterior adhesions of the uterine wall.  2, inflammatory factors endometrial tuberculosis, postmenopausal age-related endometritis, secondary infection after uterine operation, puerperal infection, secondary infection caused by intrauterine device placement, etc.  Clinical manifestations: 1.Menorrhea and amenorrhea: mild and moderate uterine cavity adhesions can lead to menorrhea, and severe cavity adhesions can lead to amenorrhea, and estrogen and progesterone cycle treatment is ineffective.  2. Periodic abdominal pain: Patients with scanty menstruation or amenorrhea have mild periodic abdominal pain. It indicates that normal endometrium still exists and the prognosis of hysteroscopy is better.  3. Infertility: secondary infertility or recurrent miscarriage and preterm delivery. The endometrium of the uterus is damaged due to cavity adhesions, and the volume of the uterus is reduced, which affects the normal embryonic implantation and leads to infertility, and even if conception occurs, it affects the growth and development of the embryonic trophoblast after implantation and leads to miscarriage and preterm delivery.  Treatment: At present, hysteroscopy is effective in diagnosing and treating uterine adhesions, and the effect is fast. The hysteroscopic separation of severe uterine adhesions is a level 4 operation, which is more difficult and requires consultation with a specialized hospital.  Prevention: 1, women of childbearing age should implement good contraceptive measures, avoid abortion and induced abortion, especially the first abortion may cause cavity adhesions, secondary infertility.  2, gynecological surgery should be actively treated before vaginitis, chronic cervicitis, endometritis, etc., to prevent postoperative infection.  3, the gynecologist should not be rough when dilating the cervix during the abortion, and should not jump the number with dilators to avoid damaging the cervical canal. The negative pressure should be appropriate when attracting, and the negative pressure should be closed when entering and leaving the cervix. The depth should be moderate when scraping the uterus.