(Disclaimer: This article is for general science purposes only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: In this article, the patient had a significantly decreased menstrual flow after an early pregnancy abortion in 2019, and was initially diagnosed with uterine adhesions (moderate mixed type), for which hysteroscopic surgical treatment was recommended. The patient underwent hysteroscopic hysteroscopic adhesion separation under general anesthesia, and the uterine cavity returned to its normal shape and conception was successful. Common symptoms of uterine adhesions are amenorrhea, or menorrhagia, abdominal pain, secondary infertility, and miscarriage, etc. If the corresponding symptoms appear, promptly visit the hospital.
Basic information】Female, 30 years old
Disease Type】Uterine adhesions (moderate mixed type)
Hospital】Wuhan Children’s Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology
Date of consultation】March 2021
Treatment plan】Surgical treatment (hysteroscopic separation of uterine adhesions) + medication (cefuroxime sodium for injection + estradiol tablets/estradiol digoxigenone tablets)
Treatment period】Outpatient follow-up treatment for 3 months in total
Results】The uterine cavity returned to its normal shape and natural conception was achieved.
I. Initial consultation
The patient was not treated for a significant decrease in menstrual flow after an early abortion in 2019, and started to prepare for pregnancy in early 2020. She came to the hospital with a need for fertility. Menstrual and marital history: regular periods, 5-6/28-30 days, decreased menstrual volume since 2 years ago, mild dysmenorrhea, G1P0A1, indicating one pregnancy, no births and one miscarriage. It is recommended to perform 3D ultrasound + blood AMH and semen analysis for the male partner. The 3D ultrasound suggested: possible uterine adhesions, AMH 2.3ng/ml; no significant abnormalities in the male partner’s semen routine.
II. Treatment history
After talking with the patient and the couple, we suggested the female partner to separate the uterine adhesions by hysteroscopy first, and then prepare for pregnancy normally, which would increase the pregnancy rate. After completing the relevant preoperative examination, the patient underwent hysteroscopic separation of uterine adhesions under general anesthesia. The hysteroscopic examination showed that the uterine cavity was circumferentially narrowed, the volume was small, fibrous membranous adhesions at the base of the uterus, bilateral walls and anterior wall, and the opening of both fallopian tubes were visible, and the micro-scissors separated the adhesions at the base of the uterus and the anterior and bilateral walls. Intraoperative vital signs were stable, and the patient was awake after surgery and did not complain of any special discomfort. Diagnosis: uterine adhesions (moderate mixed type). After the first hysteroscopy, in addition to the usual anti-infective treatment with cefuroxime sodium for injection, estradiol tablets/estradiol digestrol tablets were also given to promote better endometrial repair and prevent the recurrence of adhesions.
III. Treatment effect
After the operation, the patient was also given antibiotic medication for infection treatment and artificial cycle treatment for 1 month, and was forbidden to take a bath and have sex for half a month. The hysteroscopy showed that the morphology of the uterine cavity was generally normal and the O-ring was visible in the uterine cavity. A number of membranous adhesions were seen in the uterine cavity and were separated using the scope. Bilateral uterine horns and bilateral tubal openings were visible. It was seen that the patient’s uterine cavity was recovering well. Ovulation monitoring was then recommended to guide intercourse and outpatient ovulation monitoring was initiated. The purpose of ovulation monitoring was to provide real-time intervention if necessary (suboptimal follicular development, thin endometrium) depending on the patient’s condition. Ovulation monitoring was performed for 2 months and the patient successfully conceived.
IV. Notes
We are sincerely happy for the patient’s successful conception. We advised the patient that she should take rest after surgery, avoid heavy physical labor, pay attention to keeping her abdomen warm, keep her perineal area clean, change her underwear regularly to prevent infection, and follow up promptly if her bleeding is greater than her usual menstrual flow. In addition, reasonable nutrition is needed during pregnancy, to change bad habits and lifestyles, such as smoking, alcoholism and drug abuse; to eat a reasonable and balanced diet, do not eat spicy and stimulating food, and avoid cold; to avoid high-intensity work and high-noise environment; to avoid contact with toxic and harmful substances, such as radiation, heavy metals, pesticides, etc.
V. Personal insight
Uterine adhesion refers to the destruction of the basal layer of the endometrium after stimulation, resulting in mutual adhesion of the myometrium and partial or complete occlusion of the uterine cavity, which is common after abortion or intrauterine infection. The patient in this case is a case of uterine adhesions caused by decreased menstruation after abortion but no medical consultation, so it is important to seek medical attention for symptomatic treatment and care when symptoms are present. Hysteroscopy is currently an effective means of treating uterine adhesions and is also the gold standard for diagnosis. However, hysteroscopic operation can also bring some trauma to the uterus. A small amount of vaginal bleeding is usually normal and most of it will stop in about 1 week. If symptoms such as heavy vaginal bleeding, abdominal pain and nausea occur after the operation, they should be treated as soon as possible to avoid endangering women’s health.