1.What is intrauterine adhesion (IUA)? IUA, also known as Asherman’s syndrome, is a series of clinical lesions caused by uterine surgical operation or endometrial destruction due to infection or radiation, mostly occurring after suction or curettage, endometrial tuberculosis, severe intrauterine infection, removal of submucosal fibroids, or cesarean section, etc., which can damage the endometrium and lead to IUA. endometrium leading to IUA. Approximately 15-20% of all clinically confirmed pregnancies end in miscarriage. Uterine adhesions are a complication of miscarriage with a reported incidence of about 25%. More than half of these patients have mild adhesions and their clinical relevance is unknown. Repeated abortions and curettage have been identified as risk factors for adhesion formation. No studies have reported an association between post-abortion uterine adhesions and long-term reproductive outcomes, which are similar after conservative, pharmacologic, or surgical treatment. Asherman syndrome is defined as secondary amenorrhea caused by destruction of the endometrium. It usually occurs when the endometrial basal layer is damaged and adherent due to excessive scraping after labor or abortion; adhesions can partially or completely obstruct the uterine cavity, endocervical os, cervical canal, or many of the above, resulting in endometrial dysfunctional or obstructive amenorrhea. 2.How is the pathogenesis of uterine adhesions? The front and back walls of normal uterine cavity are close to each other, but due to the anatomical characteristics, the surface of the muscle layer is covered with a complete layer of endometrium, which is divided into two layers according to its physiological characteristics, i.e., the functional layer and the basal layer, with the change of the ovarian cycle, the endometrium also shows cyclic changes, and the stripping of the functional layer occurs in the menstruation period, and the basal layer will be re-grown and repaired, and the uterine cavity will not be adhered to. However, if the basal layer of the endometrium is damaged and cannot grow back, leaving the muscle layer of the uterine cavity exposed, then uterine adhesions will occur. Uterine adhesion usually occurs in pregnancy after endometrial injury, especially after delivery or abortion within 1-4 weeks after scraping, often causing endometrial basal layer damage, fibrous scar formation so that the uterine cavity narrowing, distortion and deformation, due to the fibrinogen exudate, precipitation and then secondary infections can be formed in the uterine cavity adhesion. 3.What are the manifestations of uterine adhesions? Due to the different parts and scope of adhesion, the clinical characteristics of uterine cavity adhesion are not the same, the main manifestations are: menstrual abnormalities, secondary menorrhagia or amenorrhea, abortion or scraping after menorrhagia, amenorrhea and cyclic lower abdominal pain; secondary dysmenorrhea, infertility, early abortion, ectopic pregnancy, as well as delivery of the placenta implantation, postpartum hemorrhage, and so on. 4.How to categorize uterine adhesion? Clinical symptoms and reproductive prognosis are closely related to the classification and scope of uterine adhesions, so they can be observed and categorized according to the site, degree and nature of adhesions. (1) Adhesion site Adhesion of the endocervix or cervical canal: the probe or hysteroscope can not enter the uterine cavity through the cervical canal; Uterine adhesion: central type: adhesion is located in the anterior and posterior walls of the uterus; peripheral type: adhesion is located in the bottom of the uterus or the side wall of the uterus, especially in the uterine horn. They are located in the uterine fundus or in the lateral wall of the uterus, especially in the uterine horns. They make the uterine horns atresia and the tubal openings are not visible, especially in the unicornuate uterus. Uterine adhesions can be manifested as all the adhesions of the uterine cavity and cervical canal. (2) Degree of adhesion: mild: adhesion area is less than 1/4 of the uterine cavity; moderate: adhesion area accounts for 1/4-1/2 of the uterine cavity; severe: adhesion area is more than 1/2 of the uterine cavity. (3) Nature of adhesion: endometrial adhesion: brittle and soft, loose and easy to separate, white at the broken end without bleeding, mostly seen in the central type. Muscular adhesions: the surface has many glandular openings, separation requires a little force, the broken end is rough and red, with bloody exudation. Connective tissue adhesion: the surface is gray, glossy, without endothelial coverage, the severed end is pale without bleeding. 5.How to diagnose uterine adhesion? Most patients have the change of reduced menstrual flow or amenorrhea after curettage, and some patients have the history of abdominal pain, dysmenorrhea, secondary infertility or repeated abortion. Uterine adhesions are sometimes asymptomatic in patients and are discovered unintentionally during ultrasound. Premenstrual three-dimensional ultrasound can improve the diagnosis rate of uterine adhesion, and hysteroscopy or uterine tubal iodine oil angiography can also be applied to help diagnose. Painless abortion and repeated abortions have increased the prevalence of severe uterine adhesions, and the fertility status of patients is worrying; some poor areas, private and grassroots hospitals do not standardize the diagnosis and treatment of uterine adhesions in a timely manner, and repeated uterine operations aggravate the uterine adhesions, and a large number of patients have lost the chance of having children. 6.How to deal with uterine adhesion? Surgical decomposition of cervical and uterine adhesions, used to use cervical dilator and curettage to decompose adhesions, now the use of hysteroscopic visualization of mechanical (scissors) cutting or laser cutting of adhesion bands, the effect is better than blind operation. At the same time, a contraceptive ring is placed in the uterine cavity. Those who need to have children should also take a large dose of estrogen for 2-3 cycles. 7.Can adhesions reoccur after separation of uterine adhesions? Sometimes. The reoccurrence of adhesions depends on the original lesion in the uterine cavity and the extent of destruction of the endometrium during the operation. Most scholars now advocate the placement of an IUD in the uterine cavity after separation of severe or fibrous connective tissue adhesions to avoid the formation of adhesions in the separation wound. In addition, the use of postoperative antimicrobial agents to prevent perioperative infections is also one of the measures to prevent the re-formation of adhesions. After separation of uterine adhesions, it is necessary to promote the regeneration and repair of the endothelium around the original trauma of the uterine cavity, which not only reduces the possibility of re-adhesion, but also is directly related to the restoration of the menstrual cycle and the improvement of reproductive function. 8.Will normal menstruation be resumed after hysteroscopic uterine adhesion separation? After hysteroscopic separation of uterine adhesions, 90% of the patients can resume normal menstruation and the symptoms of cyclic abdominal pain disappear. However, the reproductive prognosis of the patient depends on the degree, nature and extent of the adhesions. The wider the scope of the adhesions, the denser the adhesions, the more severe the destruction of the endometrium, and the lower the possibility of pregnancy. 9. How long does it take to get pregnant after treatment of uterine adhesions? After the treatment of uterine adhesions, those who wish to get pregnant need to use contraception for at least one year, because pregnancy immediately after the separation of uterine adhesions is very likely to cause abnormal development of the embryo in the uterine cavity, at this time, such as abortion is not only difficult to operate, but also to cause adhesion recurrence, adhesion range and deepen the extent of the adhesion. 10, how to prevent the occurrence of uterine adhesions? Curettage should be actively treated before the patient’s vaginitis, chronic cervicitis, endometritis, etc. in order to prevent postoperative infection; if the dilatation of the cervix can not be rough, with a dilator can not jump the number, in order to avoid damage to the cervical canal; attraction of the negative pressure should be appropriate, in and out of the cervix to turn off the negative pressure; lifting of the adhesion of the method of the available probes or a small expansion can be effective in the use of placing intrauterine contraceptive device, but also the application of adrenocorticosterone to prevent fibrosis, or oestrogen, progesterone, and other drugs. , or estrogen, progesterone do artificial cycle to effectively carry out the treatment. The key to preventing uterine adhesions is family planning, reducing the number of abortions and induced abortions, and avoiding early sexual intercourse after surgery. The key to preventing uterine adhesions is family planning, reducing the number of abortions and induced abortions, and avoiding early sexual intercourse after the operation. Try to go to a larger regular hospital for abortion and uterine evacuation, and use antimicrobials to prevent infections before the operation.