Uterine adhesions 2-4-4 are from the AFS score that determines the classification of uterine adhesions as severe. The normal endometrium may be damaged or infected by surgery and scar tissue may form in the uterine cavity, causing adhesions. If the adhesions are combined with clinical symptoms, such as infertility or absence of menstruation, the condition is called Asherman’s syndrome, or uterine adhesions. There are several criteria for grading uterine adhesions, such as the 1988 American Fertility Society (AFS) score, as follows. 1. Extent of adhesion involving the uterine cavity: less than 1/3 – 1 point, 1/3 to 2/3 – 2 points, more than 2/3 – 4 points. 2. Adhesion part: thin – 1 point, thin part of dense – 2 points, dense – 4 points. 3. Menstrual flow: no change – 0 points, decrease – 2 points, amenorrhea – 4 points. Mild uterine adhesions (uterine adhesions grade I) – 1 to 4 points, moderate uterine adhesions (uterine adhesions grade II) – 5 to 8 points, severe uterine adhesions (uterine adhesions grade III) – 9 to 12 points There is also the European Society of Gynecologic Endoscopy (ESGE) classification of 2000.