caa a22 4500 445363975 CHVBK 20180317142923.0 cr unu---uuuuu 170323e20111101xx s 000 0 eng 10.1007/s10397-011-0677-5 doi (NATIONALLICENCE)springer-10.1007/s10397-011-0677-5 Asherman's syndrome after removal of placenta remnants: a serious clinical problem [Elektronische Daten] [A. Hooker, A. Thurkow] Intrauterine adhesions (IUA) or Asherman's syndrome is thought to develop after trauma to the uterine cavity by destruction of the basal layer of the endometrium. IUA can result in menstrual disorders, infertility, and complication during pregnancy and delivery. IUA formation is multifactorial, with pregnancy being an important etiologic factor. Performing a postpartum exploration/evacuation or curettage can lead to adhesion formation. We present three patients who presented with a menstrual disorder after postpartum surgical intervention on suspicion of placental remnants. Hysteroscopic evaluation revealed severe intrauterine adhesions with complete obliteration of the uterine cavity. Repeated and extensive hysteroscopic adhesiolysis is performed to acquire a cavity with a normal appearance. Besides the puerperal uterus, the time of surgical performance is crucial in the risk for adhesion formation. Performing a late surgical intervention, as from 24-48h after delivery, leads to an increased risk for adhesion formation. Prevention of IUA can be established by an accurate indication for late postpartum surgical interventions. When performing a late surgical intervention, hysteroscopic surgery is preferable. Firstly, hysteroscopy allows the possibility for identification of placental remnants, and secondly, the possibility for selective removal, thus avoiding unnecessary trauma to the endometrium compared to blindly curettage. Caution is advised when performing a late puerperal surgical intervention. An accurate indication is essential, and when needed, hysteroscopic surgery is preferable, minimizing trauma to the endometrium. Springer-Verlag, 2011 Asherman's syndrome nationallicence Adhesion nationallicence Pregnancy nationallicence Placental remnants nationallicence Surgical intervention nationallicence Puerperium nationallicence Prevention nationallicence Curettage nationallicence Hooker A. Department of Obstetrics and Gynaecology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands aut Thurkow A. Department of Obstetrics and Gynaecology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands aut Gynecological Surgery Springer-Verlag 8/4(2011-11-01), 449-453 1613-2076 8:4<449 2011 8 10397 https://doi.org/10.1007/s10397-011-0677-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10397-011-0677-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hooker A. Department of Obstetrics and Gynaecology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Thurkow A. Department of Obstetrics and Gynaecology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands aut NATIONALLICENCE 773 0- Gynecological Surgery Springer-Verlag 8/4(2011-11-01), 449-453 1613-2076 8:4<449 2011 8 10397 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer