Treatment of Asherman's syndrome in an outpatient hysteroscopy setting

To evaluate the feasibility and success rate of treating Asherman syndrome in an outpatient hysteroscopy unit.

Retrospective case series (Canadian Task Force classification III).

The outpatient hysteroscopy clinic at Ottawa Hospital from November 26, 2008, to January 31, 2014.

Patients undergoing treatment for Asherman syndrome.

All cases of hysteroscopic adhesiolysis were reviewed.

Demographic data were collected by a retrospective chart review including patients' age, obstetric history, referring complaint, etiology of Asherman syndrome, antecedent treatment, and outcome measures when available. The severity of Asherman syndrome was determined based on the March classification by the operating surgeon. Analgesia used during the procedure was recorded. Twenty patients were treated for Asherman syndrome in the outpatient hysteroscopy suite. There were a total of 38 procedures (adhesiolysis or diagnostic hysteroscopies) performed for this indication in the patient set. The most common etiologies for intrauterine adhesions were previous curettage (60%) and previous missed abortion (45%). Outcomes were available for 19 patients. All of the patients had normal menses after treatment. Eighty-four percent of patients had either no adhesions or mild adhesions at their final hysteroscopy. Six patients had a spontaneous pregnancy after treatment, and 5 went on to have a term delivery to date. In terms of analgesia used for the procedure, 89% of patients had preoperative nonsteroidal anti-inflammatory drugs, 2.8% required intravenous fentanyl and midazolam, and 5.6% required oral lorazepam.

This series showed that Asherman syndrome may be successfully treated in an outpatient hysteroscopy setting outside the operating room and without general or regional anesthesia.