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Abstract: This case is a 27-year-old mother who suffered from endometrial damage due to placental tissue residue after delivery of her second child and painless uterine removal surgery. Ultrasound indicated “thin endometrium and multiple slightly hypoechoic bands in the uterine cavity (consider uterine adhesions)”, and she was given a hysteroscopic adhesion separation, an intrauterine device and medication. The treatment result was good, the endometrium was repaired and the menstrual flow was normal.
Basic information】Female, 27 years old
Type of disease】Uterine adhesions
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of consultation】March 2022
Treatment plan】Surgical treatment (hysteroscopic adhesion separation, intrauterine device placement) + medication (cefuroxime sodium for injection, metronidazole injection)
Treatment period】5 days of inpatient treatment, 1 month of outpatient review
Treatment effect】Good treatment effect, endometrial repair, normal menstrual flow
I. Initial consultation
The patient had normal menstruation, one abortion and two normal deliveries. Self-report: After the second normal delivery in 2019, she found residual placental tissue and underwent painless uterine removal surgery. A few months ago, she began to pay attention to diet and exercise to regulate her body, but her menstrual flow was still low. After her menstruation in early January this year, she did not have a menstrual flow for nearly 2 months, so she went to our clinic on March 14.
The ultrasound showed that “the endometrium is thin, the echogenicity is uneven, there are multiple slightly hypoechoic bands in the uterine cavity (consider uterine adhesions), cervical cysts and pelvic effusion”. The final diagnosis was “uterine adhesions”, so the patient was admitted to the hospital for treatment.
(Outpatient ultrasound examination)
II. Treatment process
The patient agreed to undergo surgery after communication about her condition and treatment plan. After completing the blood routine, coagulation function, liver function, kidney function, leukocyte examination and electrocardiogram, it showed no obvious contraindication to surgery. Preoperatively, we explained the surgical approach to the patient and planned to try to completely loosen the uterine adhesions through the hysteroscope. Since the patient had no requirement for childbirth, an intrauterine device was given to reduce the chance of re-adhesion of the uterine cavity and to prevent pregnancy, and the patient agreed. The patient then underwent hysteroscopic surgery in the operating room under intravenous anesthesia. The hysteroscopic examination showed that the uterine cavity was shrunken, the endometrium was thin, the uterine cavity was barrel-shaped, the walls of both sides of the uterine cavity were coalescing, and dense adhesions were formed on the lateral walls and the fundus of the uterus. After the operation, anti-inflammatory treatment with cefuroxime sodium for injection and metronidazole injection was applied in order to reduce the chance of infection.
III. Treatment effect
After surgical treatment, the patient’s uterine adhesions were completely loosened. The patient’s vital signs were normal, no fever, no abdominal pain, no infection, the patient felt normal, and the routine blood tests were normal, so the patient was discharged. Twenty-five days after discharge, the patient had her menstrual flow, which cleared in 6 days, and her menstrual flow returned to normal. After her menstruation cleared (about 1 month after discharge), she went to the outpatient clinic for a follow-up ultrasound examination of her uterus, which showed that the position of the intrauterine device was normal, no uterine adhesions occurred again in the uterine cavity, and the endometrium was repaired, and the treatment effect was good.
IV. Notes
We are glad that the patient’s menstruation returned to normal after the surgical treatment and medication. After discharge, the patient was advised to avoid intercourse in the near future, otherwise it would easily lead to infection and displacement of the IUD. In daily life, pay attention to personal hygiene to reduce the possibility of developing uterine inflammatory disease. Diet should be light and easy to digest, avoid cold and stimulating things that may cause discomfort. After recovery, exercise should be done in appropriate amounts according to individual conditions to help keep menstruation normal. In addition, after the IUD is placed, it is recommended to have an ultrasound examination of the uterus every year to see if the position of the IUD is normal, and if it is displaced, it will not work as a contraceptive and needs to be replaced.
V. Personal insight
In this case, although the patient is a young mother, most of the postpartum placental tissue residue has intrauterine inflammation, so after the postpartum operation, the endometrial trauma is exposed, and the inflammation will easily lead to uterine cavity adhesions, plus the patient’s postpartum breastfeeding, labor caused by weakness and immune system decline, and then the endometrial blood supply and nutrition is insufficient, resulting in thin endometrium. The dual effect of cavity adhesions and endometrial thinning can lead to low menstrual flow and even amenorrhea. In such cases, it is necessary to go to the hospital as soon as possible to find the cause and give hysteroscopy to release the adhesions to help restore menstruation.