Publicação
Asherman syndrome : current and future perspectives on treatment and prevention of recurrence
| Resumo: | Background: Asherman syndrome (AS) is characterized by the presence of adhesions in the uterine cavity. Clinical presentation includes amenorrhea/hypomenorrhea and dysmenorrhea. It is associated with a high rate of infertility and pregnancy complications. Objective: To provide an update on the management of AS, with special regard to the future perspectives on treatment and prevention of recurrence. Study design: Literature review. Search methods: A literature search was conducted using MEDLINE, PubMed and The Cochrane Library electronic resources. The searched keywords included the terms “Asherman's syndrome”, “Asherman syndrome”, “intrauterine synechiae”, “uterine synechiae” and “intrauterine adhesions”. The search was restricted to studies published in the last 5 years and written in English or French languages. Discussion: Comprehensive management, consisting in hysteroscopic adhesiolysis followed by postoperative prevention of recurrence, provides the best possible outcomes. New developments in hysteroscopy, such as ultrasound guidance and office hysteroscopy, have contributed to an overall success rate of 95% and a low rate of complications. However, intrauterine adhesions (IUAs) recurrence is a major problem, occurring in 28.7% of patients who had successful adhesiolysis. Several methods to prevent IUAs recurrence have been proposed: (1) mechanical devices, including various types of intrauterine balloons and intrauterine devices; (2) postoperative estrogen therapy; (3) barrier gels (hyaluronic acid and its derivates) and (4) human amniotic membrane grafting. Stem cells (SCs), specifically bone marrow-derived SCs, have been explored as a new therapeutic strategy in AS, with promising results. However, more randomized controlled studies are needed to confirm these results. Conclusions: Hysteroscopic adhesiolysis is the established gold standard for IUAs treatment, with proven safety and efficacy. Over the last years, the focus has been on the prevention of IUAs recurrence, with the development of several effective methods. Finally, recent experimental studies highlight SCs therapy as a promising therapeutic option for AS. |
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| Autores principais: | Guerra, Ana Teresa Baltazar Bação |
| Assunto: | Síndrome de Asherman Sinéquias intrauterinas Infertilidade Adesiólise histeroscópica Terapia com células estaminais Obstetrícia |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background: Asherman syndrome (AS) is characterized by the presence of adhesions in the uterine cavity. Clinical presentation includes amenorrhea/hypomenorrhea and dysmenorrhea. It is associated with a high rate of infertility and pregnancy complications. Objective: To provide an update on the management of AS, with special regard to the future perspectives on treatment and prevention of recurrence. Study design: Literature review. Search methods: A literature search was conducted using MEDLINE, PubMed and The Cochrane Library electronic resources. The searched keywords included the terms “Asherman's syndrome”, “Asherman syndrome”, “intrauterine synechiae”, “uterine synechiae” and “intrauterine adhesions”. The search was restricted to studies published in the last 5 years and written in English or French languages. Discussion: Comprehensive management, consisting in hysteroscopic adhesiolysis followed by postoperative prevention of recurrence, provides the best possible outcomes. New developments in hysteroscopy, such as ultrasound guidance and office hysteroscopy, have contributed to an overall success rate of 95% and a low rate of complications. However, intrauterine adhesions (IUAs) recurrence is a major problem, occurring in 28.7% of patients who had successful adhesiolysis. Several methods to prevent IUAs recurrence have been proposed: (1) mechanical devices, including various types of intrauterine balloons and intrauterine devices; (2) postoperative estrogen therapy; (3) barrier gels (hyaluronic acid and its derivates) and (4) human amniotic membrane grafting. Stem cells (SCs), specifically bone marrow-derived SCs, have been explored as a new therapeutic strategy in AS, with promising results. However, more randomized controlled studies are needed to confirm these results. Conclusions: Hysteroscopic adhesiolysis is the established gold standard for IUAs treatment, with proven safety and efficacy. Over the last years, the focus has been on the prevention of IUAs recurrence, with the development of several effective methods. Finally, recent experimental studies highlight SCs therapy as a promising therapeutic option for AS. |
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