Removal of synechiae in the uterus. Dissection of synechiae Causes of formation of intrauterine synechiae

Intrauterine synechiae - adhesions in the uterine cavity.

The appearance of synechiae in the uterine cavity leads to atrophic changes in the endometrium, which entails disruption of menstrual function. In addition, intrauterine synechiae are a mechanical obstacle to the advancement of sperm, as a result of which the woman suffers from infertility. There are also poor conditions for implantation of the fertilized egg, which leads to spontaneous abortion.

The trigger for the formation of intrauterine synechiae is damage to the basal layer of the endometrium, which, in turn, can be caused by various factors. The most common factors include:

• surgical termination of pregnancy;
• previous frozen pregnancy, in which possible remnants of the placenta in the uterine cavity contribute to the formation of collagen fibers;
• presence of intrauterine contraceptives;
• diagnostic curettage of the uterine cavity, carried out for endometrial polyps, fibroids, uterine bleeding, and so on;
• endometritis is an inflammatory disease that affects the endometrium;
• genital tuberculosis;
• radiation therapy performed for malignant tumors of the uterus or ovaries.

With timely detection, the prognosis of the disease is favorable, in most cases it is possible to restore menstrual and reproductive function. An unfavorable outcome is observed with intrauterine synechiae of tuberculous etiology. In this case, it is extremely rare to restore the condition of the endometrium. In addition, after dissection and removal of synechiae of any origin, there is a risk of the formation of new ones. Since intrauterine synechiae are a mechanical obstacle to the advancement of sperm, women often suffer from infertility. In this regard, such patients are offered assisted reproductive technologies, including in vitro fertilization. However, unfortunately, in some cases, even with the help of assistive technologies, women are unable to bear a fetus. In this case, it is proposed to consider the option of carrying a fetus through surrogacy.

Symptoms

As a rule, the presence of intrauterine synechiae is manifested by the development of hypomenstrual syndrome. This syndrome is characterized by the following:

• rare and short menstruation;
• low blood loss during menstruation compared to the physiological norm.

In rare cases, women with intrauterine synechia experience secondary amenorrhea (a pathological condition characterized by prolonged absence of menstruation in women who previously menstruated). When the lower parts of the uterine cavity are obliterated during menstruation, a hematometra can form - an accumulation of blood in the uterine cavity, resulting from a violation of its outflow. This phenomenon is accompanied by the appearance of pain in the lower abdomen. In most cases, the pain is cramping in nature.

Since the presence of intrauterine synechiae prevents implantation of the fertilized egg, women often suffer from infertility or miscarriage. The formation of synechiae in the fallopian tubes makes the process of fertilization impossible, which also leads to infertility. In such cases, artificial insemination techniques can be used, however, unfortunately, the presence of even the most minimal synechiae in the uterine cavity disrupts the implantation process, which can cause the ineffectiveness of in vitro fertilization.

Diagnostics

Diagnosis begins with clarifying the patient’s complaints, in particular assessing menstrual and reproductive function. You should also find out whether the woman has a history of abortions, intrauterine manipulations, for example, endometrial curettage, or inflammatory diseases of the reproductive organs. This is important to know, since it is these factors that often become the cause of the development of intrauterine adhesions.

Unfortunately, ultrasound of the pelvic organs in this case is a low-informative study, since the presence of intrauterine synechiae can be indirectly judged only by the irregular contours of the endometrium. The presence of a hematometra, which is expressed as an anechoic formation in the uterine cavity, is clearly visualized on ultrasound. The most informative are the following studies:

• hysteroscopy is an endoscopic research method that allows you to examine the uterine cavity using a hysteroscope. In the future, if necessary, not only diagnostic procedures, but also therapeutic ones can be carried out. Intrauterine synechiae are visualized as avascular whitish cords. These cords have different densities and lengths and connect the walls of the uterus. Due to their presence, deformation or obliteration of the uterine cavity is noted;
• Hysterosalpinography is an x-ray examination method that allows you to assess the patency of the uterus and fallopian tubes. However, it is worth noting that in some cases this study gives a false positive result due to the presence of mucus, endometrial debris, and so on in the uterine cavity.

Hormonal tests may also be prescribed, which are assessed by the presence of menstrual-like bleeding in response to estrogen and progesterone. In this condition, the hormonal test will be negative. In addition, the level of sex hormones is assessed, which is within normal limits, which indicates the normogonadotropic nature of amenorrhea.

Treatment

The main goal of treatment is to eliminate existing intrauterine synechiae, thereby restoring menstrual and reproductive function.

Of course, the most effective method is surgical hysteroscopy, during which adhesions are dissected under the control of an optical device. Hysteroresectoscopy allows you to eliminate the existing problem without resorting to more complex interventions. Since this manipulation is considered minimally invasive, as a rule, the development of any complications is extremely rare in the future.

After surgical manipulation, the woman is prescribed hormone therapy, the effect of which is aimed at stimulating the restoration of the endometrium, as well as its cyclic transformation. It is important to note that in no case should you use combined oral contraceptives, since these drugs act on the endometrium, causing atrophic changes in it.

Since the formation of synechiae in the uterine cavity is often associated with inflammatory diseases of the genital organs, it is important to use antibacterial agents, the action of which is aimed at destroying pathogenic microflora. To avoid the development of a chronic form of inflammatory disease, which is often the cause of the appearance of intrauterine synechiae, it is necessary to carefully follow all the doctor’s recommendations during treatment of the acute form of the disease. You should also be careful when taking antibiotics; in particular, you should never discontinue the drug yourself or adjust the dosage and frequency of administration. In addition, after stopping the acute inflammatory process, physiotherapeutic treatment is prescribed, which reduces the possibility of the formation of adhesions in the pelvis. The following types of physiotherapy are used:

• UHF is a physiotherapeutic treatment method based on the use of an ultra-high frequency electromagnetic field;
• Magnetic therapy is a physiotherapeutic procedure based on the effect of a magnetic field on the body;
• electrophoresis with magnesium, zinc or hyaluronidase - administration of a drug through the skin or mucous membranes using a direct electric current;
• Diadynamic therapy is a method of physiotherapeutic treatment based on the use of electrical currents of various frequencies and powers.

Medicines

As is known, the main method of treating intrauterine synechiae is their dissection and removal during hysteroresectoscopy. After this surgical procedure, the woman is prescribed hormone therapy, which helps restore the endometrium. The selection of hormonal drugs is carried out by a specialist strictly individually in each individual case. While taking hormonal drugs, you should carefully follow all the doctor’s recommendations, and also not self-medicate, in particular, do not adjust the dose of the drugs or stop taking them without the knowledge of your doctor. Under no circumstances should combined oral contraceptives be used, since these drugs, on the contrary, cause atrophic changes in the endometrium.

If the disease is infectious, antibacterial agents are prescribed, the action of which is aimed at destroying pathogenic microflora. The choice of a specific group of antibiotics is based on the results of a study of scrapings from the cervical canal and cervix. Based on this study, it is possible to identify pathogenic microorganisms that are the cause of the development of the inflammatory disease, as well as determine their sensitivity to the antibiotics used. As a rule, until the results of the study are obtained, preference is given to broad-spectrum antibacterial drugs that act on both gram-positive and gram-negative microflora.

Folk remedies

Folk remedies are not used in the treatment of intrauterine synechiae, but their use can be encountered in the treatment of inflammatory diseases of the reproductive system, since they are often the cause of adhesions. In this case, traditional medicine based on herbal components is used for preventive purposes. It is also worth noting that these drugs should be used exclusively as an addition to the main treatment prescribed by a qualified specialist. We bring to your attention the following recipes, before using which you should consult with your doctor:

• To prepare the infusion you will need: 1 tablespoon of chamomile, 2 tablespoons of marshmallow leaves and 1 tablespoon of sweet clover herb. Mix the listed components thoroughly and pour in 1 cup of boiling water, let it brew for 20 minutes, then strain through a strainer. It is recommended to take ¼ cup 2 times a day after meals;
• mix 6 tablespoons of oak bark and 4 tablespoons of linden flowers. From the resulting collection, to prepare the infusion, you will need 4 tablespoons of raw materials, which are poured with 1 liter of boiling water and infused for 5 minutes, after which the infusion is carefully filtered. It is recommended to use for douching 2 times a day;
• take 4 tablespoons of dried chamomile flowers, pour 1 glass of boiling water over them, let it brew for 10 - 20 minutes. The infusion becomes ready for use after careful straining. It is recommended to take ½ glass orally 2 times a day;
• Take 1 tablespoon of pre-prepared plantain leaves, pour two glasses of boiling water, let it brew for 15 - 20 minutes, then strain through a strainer. The resulting infusion is consumed 1 tablespoon 3 – 4 times a day.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Synechia in the uterine cavity is in most cases an incomprehensible term, the meaning of which many understand only when faced with a problem. In this review, I want to help women learn more about the disease and the possibilities of getting rid of it.

1. Synechiae are adhesions in the uterus that form as a result of inflammatory, infectious and purulent processes, operations and abortions.
2. The main symptoms of adhesions are pain, disturbance of urination and outflow of menstrual blood.
3. Synechiae are classified according to the degree of development, type of tissue and prevalence.
4. Adhesions are diagnosed using ultrasound.
5. Treatment is carried out both conservatively and surgically. When planning pregnancy, adhesions must be removed.
6. In the absence of timely treatment, increased pain, uterine deformation, miscarriage and infertility are possible.

Definition

Synechiae are connective tissue adhesions that appear in the uterus due to inflammation. They can tighten, deform the organ, and close gaps.

Symptoms

The main sign of adhesions is pain, which intensifies in the following cases:

There may also be problems with urination, defecation, and the flow of menstrual blood.

Causes

Synechia in the uterus is a type of complication that can occur after:

• inflammation;
• infections;
• suppuration;
• surgical interventions, abortions.

Classification

Synechiae are subdivided depending on the composition of the tissue, location, and degree of development.

According to histology

1. Mild form - adhesions are thin and consist of epithelium.
2. Medium - synechiae are dense muscle formations grown into the endometrium. When cut they bleed.
3. Heavy - the tissue that makes up the synechiae becomes connective and difficult to excise.

The disease can be cured at any stage; only the volume of interventions performed differs.

By prevalence

1. First type: up to 25% of the uterine cavity is affected, the mouths of the tubes are not affected.
2. Second: the adhesions affected 25-75% of the organ and the mouth, the walls do not stick together.
3. Third: more than 75% of the cavity, tubes are involved, the walls stick together and the uterus is deformed.

With the third type of pathology, the likelihood of conceiving a child is minimal.

According to the degree of damage and closure of cavities and lumens

This is a classification generally accepted by gynecologists and used during surgical interventions. According to it, there are 6 degrees of uterine damage:

• I - thin, easily dissected adhesions;
• II - compacted synechiae;
• II-a - location of adhesions in the internal pharynx;
• III - many dense synechiae with damage to the mouths of the fallopian tubes;
• IV - partial occlusion of the cavity;
• V - scars on the walls of the organ.

Watch the video on the topic “Synechia in the uterine cavity”:

Diagnostics

Synechiae are easily identified by ultrasound. Ultrasound examination makes it possible to determine their location, degree of damage, etc.

In addition, a hysteroscopic diagnosis of the uterus is carried out (if there is access to the cavity) and synechiae tissue is taken for histology.

Effect on pregnancy

Synechiae most often cause problems with conception, because they can affect the cervical canal and fallopian tubes. If they are in the uterus, they interfere with the attachment of the fertilized egg or provoke miscarriages in the early stages of pregnancy.

During the adhesive process, the walls of the uterus are fixed at a certain distance from each other. As pregnancy progresses, the organ stretches, causing pain and hypertonicity. The consequence may be a miscarriage or termination of pregnancy for medical reasons.

Adhesions sometimes put pressure on the fetus, deform it and interfere with development. In this case, the pregnancy outcome is the same as described above.

After removal of adhesions, a woman can plan and carry a pregnancy.

Therapy

Treatment of synechiae is carried out using several methods at once. The choice of one method or another is determined by histology, location and thickness of adhesions.

Conservative

Conservative therapy includes:

1. Gynecological massage. Used for small, thin adhesions. During the massage, the synechiae are stretched and the uterus returns to its normal physiological position. This method is not suitable for those who are planning a pregnancy, because... the commissure remains in place.
2. Microwave and UHF therapy. Used in conjunction with massage. The action of microwaves promotes the resorption of thin adhesions and increases the elasticity of denser ones.
3. Physiotherapy. Just like massage, it is aimed at stretching small synechiae.

All conservative methods are used comprehensively when the disease develops insignificantly.

Radical

Radical therapy involves surgical excision of adhesions. Sometimes it is necessary to remove them completely. Such an operation cannot be performed as a cavity operation, since this can only intensify the adhesive process. Usually performed laparoscopically or hysteroscopically.

Laparoscopy involves making punctures in the abdominal wall, inserting micro-instruments and a camera into the uterine cavity, and performing an operation.

Hysteroscopy is the insertion of a special tube into the uterus through the cervical canal. Instruments and a camera are inserted through the tube. This is the least traumatic method, and therefore more preferable.

Consequences

If synechiae is not treated, the following consequences are possible:

• increased pain;
• dysfunction of organs located near the uterus;
• uterine deformation, trauma and damage;
• miscarriages;
• problems with conception, infertility.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Frequency of intrauterine synechiae in women with infertility is 55%. More often, this pathology is combined with a tubo-peritoneal factor of infertility.

The mechanism of infertility with uterine synechiae

Causes:

Without endometrial trauma, the formation of synechiae in the uterine cavity, even in the presence of inflammation, is almost impossible. Adhesions in the uterine cavity occur as a result of mechanical impact on the basal layer of the endometrium, which most often occurs during curettage, especially in the early postpartum period. Intrauterine synechiae can be the result of surgical interventions, the presence of foreign bodies in the uterus (intrauterine device, remnants of fetal fragments after abortion), as well as irrational medical manipulations in the uterine cavity (intrauterine administration of various medications for therapeutic purposes).

The second most important factor in the formation of intrauterine synechiae is chronic endometritis. In women with primary infertility and the absence of any previous manipulations in the uterine cavity, intrauterine synechiae are the result of only one specific pathological process - tuberculous endometritis.

Diagnostics

Important information for a gynecologist is the presence of a history of curettage of the uterine cavity due to artificial or spontaneous abortion, as well as other medical intrauterine manipulations. Women with synechiae in the uterine cavity often complain of pain in the lower abdomen, which intensifies during menstruation. The intensity of pain may vary. Greater pain intensity is achieved with synechiae localized in the lower third of the uterus and the cervical canal, which impedes the passage of menstrual flow. If the outflow of menstrual fluid is not impaired, the pain is not expressed.

Many patients with intrauterine synechiae complain about changes in the nature of menstruation. Menstruation becomes less abundant and shorter. With significant damage to the endometrium, they pass in the form of a “daub”. In especially severe cases, when the uterine cavity or cervical canal is completely closed, menstruation disappears (uterine form). Patients with atresia (fusion) of the cervical canal and the absence of complete damage to the endometrium, with normal ovarian function, complain of recurring monthly cyclical pain in the lower abdomen on the days of expected menstruation.

Instrumental research methods:

X-ray methods: performed by hysterosalpingography - with the introduction of contrast into the uterine cavity and a series of X-ray images. Signs of synechiae are filling defects or complete absence of filling of the uterus with contrast.

Ultrasound. The diagnostic value of ultrasound for identifying intrauterine synechiae is 60-70%. For women with amenorrhea and suspected intrauterine synechiae, it is better to have an ultrasound scan on the days of expected menstruation, and if the menstrual cycle is intact, twice: on days 8-12 of the cycle and at the end of the cycle. On ultrasound, synechiae may look like constrictions that deform the uterine cavity.

Echohysterosalpingoscopy. After expansion of the uterine cavity with a liquid medium, intrauterine synechiae are visualized as hyperechoic inclusions, constrictions that deform the cavity. The diagnostic value of the method in identifying intrauterine synechiae reaches 96%.

Magnetic resonance imaging. If necessary, it can be used to diagnose intrauterine synechiae.

Hysteroscopy. If synechia is suspected, it is carried out in a hospital in the first phase of the menstrual cycle. During this period, against the background of a thin endometrium in the uterine cavity, intrauterine synechiae are clearly visible.

Treatment

Only surgical treatment is effective, but preoperative preparation and postoperative treatment are carried out with medication.

Preoperative preparation. The goal of preoperative preparation for hysteroresectoscopy is to create reversible endometrial atrophy to ensure optimal conditions for surgical intervention. It is carried out with hormonally active drugs that affect the condition of the endometrium. The growth and maturation of the endometrium is suppressed.

Surgical intervention
A surgical operation to eliminate intrauterine adhesions and restore the patency of the uterine cavity is called hysteroresectoscopy. This operation is performed using special endostotic equipment through transvaginal access.

Postoperative treatment

Early rehabilitation treatment begins from the first day of the postoperative period, using physical and medicinal methods.

Antibacterial therapy is indicated in the early postoperative period.

Physiotherapy improves healing processes, increases local immunity, prevents the formation of new intrauterine synechiae and the development of adhesions in the pelvis. Treatment begins no later than 36 hours after surgery. They use an alternating low-frequency magnetic field, a constant magnetic field, supratonal frequency currents, and laser exposure.

What treatment is prescribed after surgery?

A repeated course of physiotherapy begins on the 5th-7th day of the menstrual cycle following surgery. The number of physiotherapy courses is determined individually. If necessary, up to three courses are carried out with an interval of at least 2 months between them.

Cyclic or hormone replacement therapy (HRT). It is performed in the treatment of women with intrauterine synechiae that arise against the background of a chronic inflammatory process. HRT promotes the complete restoration of the uterine mucosa and its complete rejection during menstruation, prevents the re-formation of synechiae in the uterine cavity, improves metabolic processes in the endometrial tissues of the uterus, which creates a favorable environment for pregnancy.

Immunomodulators are selected taking into account indicators of immune and interferon status determined before the start of surgical and drug treatment.

After completion of restorative treatment, an additional examination is carried out to assess the condition of the uterine cavity. Based on X-ray examination, echohysterosalpingoscopy or control hysteroscopy, an objective picture of the achieved results is compiled. In cases of incomplete separation of intrauterine synechiae, repeated surgical intervention and subsequent conservative complex treatment are performed.

In the absence of pathological changes in the uterine cavity, the patient is observed for 6 months (waiting period for pregnancy). Dynamic observation involves monitoring ovulation and ultrasound monitoring of the condition of the endometrium during the menstrual cycle.

Waiting tactics for 6 months are indicated provided that ovulation is present, the man is not infertile, and the menstrual cycle is adequate. If the ultrasound parameters of the endometrium do not correspond to the abundance of menstrual flow, it is necessary to repeat the therapeutic effect aimed at improving the trophic processes in the uterus (physiotherapeutic and hormonal treatment).

If ovulation defects are detected, it is stimulated for four consecutive cycles. If pregnancy does not occur within the specified period of time, additional examination is necessary to identify and analyze the reasons for unsuccessful treatment.

(Asherman's syndrome) - intrauterine adhesions leading to complete or partial obliteration of the uterine cavity. With intrauterine synechiae, hypomenstrual syndrome or amenorrhea, algodysmenorrhea, impaired reproductive function (miscarriage, infertility) are observed, and sometimes hematometra develops. Asherman's syndrome is diagnosed using ultrasound, hysteroscopy, ultrasound hysterosalpingoscopy, and hormonal tests. Treatment consists of hysteroscopic dissection of synechiae and cyclic hormone therapy. The prognosis for subsequent childbearing is determined by the severity and prevalence of intrauterine synechiae.

General information

Intrauterine synechiae are connective tissue adhesions that weld the walls of the uterus together and cause its deformation. In the presence of synechiae, the normal endometrium undergoes atrophic transformation. Intrauterine synechiae lead to disruption of menstrual function, create mechanical obstacles to the advancement of sperm, and worsen the conditions for implantation of the fertilized egg. This leads to the main manifestations of Asherman's syndrome - hypomenorrhea, secondary amenorrhea, spontaneous abortion, infertility.

Causes of formation of intrauterine synechiae

In gynecology, the development of intrauterine synechiae is associated with exposure to infectious, traumatic agents and neurovisceral factors. The most common cause of Asherman's syndrome is previous mechanical trauma to the basal endometrium. Injury to the endometrium can occur as a result of surgical termination of pregnancy, the use of intrauterine contraceptives, diagnostic curettage of the uterine cavity in case of uterine bleeding or endometrial polyps, operations on the uterine cavity (myomectomy, metroplasty, cervical conization). Damage to the endometrium can be aggravated by the addition of infection during the wound phase with the development of endometritis.

The development of intrauterine adhesions can be facilitated by genital tuberculosis, the diagnosis of which is confirmed by endometrial biopsy or bacteriological examination of menstrual discharge. Intrauterine instillations and radiation therapy for tumors of the uterus and ovaries also have a negative effect on the endometrium. Often the formation of intrauterine synechiae occurs against the background of a previous frozen pregnancy, since the remnants of placental tissue stimulate the activity of fibroblasts and the early formation of collagen before endometrial regeneration.

Classification of intrauterine synechiae

Based on the type of histological structure, 3 groups of intrauterine synechiae are distinguished. Film adhesions usually consist of basal endometrial cells, are easily dissected with the tip of a hysteroscope and correspond to a mild form of Asherman's syndrome. With a moderate degree, intrauterine synechiae are fibromuscular, tightly fused to the endometrium, and bleed when cut. The severe form of Asherman's syndrome is characterized by dense, connective tissue intrauterine synechiae, which are difficult to dissect.

Based on the degree of involvement of the uterine cavity and the prevalence of intrauterine synechiae, 3 degrees of Asherman's syndrome are distinguished. In grade I, less than 25% of the uterine cavity is involved in the pathological process, the synechiae are thin and do not spread to the fundus of the uterus and the mouth of the tubes. In stage II of the disease, synechiae occupy from 25% to 75% of the uterine cavity, there is no adhesion of the walls, and partial obliteration of the fundus and mouth of the fallopian tubes is noted. III degree of Asherman's syndrome corresponds to the involvement of almost the entire uterine cavity (>75%).

Symptoms of intrauterine synechiae

Depending on the severity of intrauterine synechiae, hypomenstrual syndrome or secondary amenorrhea may develop. When the lower parts of the uterus are obliterated while the endometrium is functionally intact in its upper parts, hematometra formation may occur.

Significantly pronounced intrauterine adhesions with a lack of functioning endometrium prevent implantation of the fertilized egg; obliteration of the tubes makes the process of fertilization impossible. Therefore, intrauterine synechiae is often accompanied by miscarriage or infertility. In addition, even the presence of mild intrauterine synechiae often becomes the reason for the ineffectiveness of in vitro fertilization.

Diagnosis of intrauterine synechiae

In most women with Asherman's syndrome, disruption of menstrual and reproductive functions is preceded by abortion, endometrial curettage, other intrauterine manipulations, and endometritis. Gynecological examination data for intrauterine synechiae are nonspecific.

Managing pregnancy in women with Asherman's syndrome requires the obstetrician-gynecologist to take into account all possible risks. The conditions for preventing the formation of intrauterine synechiae are the prevention of abortions, careful and reasonable conduct of intrauterine manipulations and operations, timely treatment of genital infections, and regular visits to the gynecologist.

Synechiae are tight connections between various organs and the appearance of connective tissue bridges between them. In gynecological practice, two types of synechiae are most often encountered: changes in the structure of the labia minora in girls and intrauterine synechiae in adults.

Synechia of the labia in young patients occurs due to a lack of the hormone estrogen at a young age, as well as due to non-compliance with the rules of personal hygiene: insufficient care of the intimate area or, on the contrary, too intensive washing using aggressive cleansers.

Adhesions of the intrauterine cavity in adult patients occur as a result of complications during childbirth, induced abortions, and various intrauterine interventions.

The main method of getting rid of unwanted connections is to cut them. Methods for dissecting synechiae in girls and defects inside the uterine cavity are fundamentally different. The need for this intervention is determined taking into account possible indications and contraindications.

Carrying out the procedure

Dissection of synechiae in girls is carried out by detaching tissue using a special tool in the form of a stick with a rounded top. Before performing this manipulation, a topical anesthetic is applied to the area that will be subjected to further mechanical pressure, after which the actual disconnection is carried out very quickly (within a few seconds). The wound is treated with an antiseptic, after which the mother can take her daughter home.

Removing unwanted tissue in the uterus is a more complex operation. The manipulation is performed using a special optical device - a hysteroscope, thanks to which the doctor is able not only to carry out disconnection and other necessary manipulations, but also to visually monitor each action.

Depending on the complexity of the upcoming operation, the type of anesthesia is selected - local anesthesia or intravenous anesthesia. During the work, the doctor can additionally use various devices, for example, a Foley catheter, endoscopic forceps or scissors, or an “electronic knife”, in order to create natural channels inside the cavity and eliminate adhesions.

The thinnest films are easily cut by the body of the hysteroscope; denser ones are removed gradually using sharper instruments. Finally, when bleeding vessels are identified in the uterus, they are coagulated to stop the release of blood.

Indications for use

Elimination of existing connections is carried out if the following indications are present:

• the presence of fusion of the labia minora in small patients, if symptoms such as the outpouring of a stream of urine to the upper side, difficulty urinating, and the appearance of vaginal discharge are observed;
• reproductive dysfunction caused by the above cause;
• scanty menstruation (or its complete absence), the cause of which is the presence of this pathology;
• pain in the affected area, intensifying immediately before menstruation.

Principles of treatment

The separation of synechiae is carried out only after preliminary instrumental diagnosis and relevant tests (ultrasound, blood test, etc.). The effect can be carried out either as a separate small operation or during simultaneous implementation of other surgical interventions (for example, removal of polyps).

Along with surgical treatment, maintaining normal hormone levels is of great importance in the postoperative period. For this purpose, it is advisable to determine the content of estrogen and other substances in the blood. If certain disorders are detected, hormonal medications may be prescribed for up to six months after surgery. If signs of inflammation are detected, antibacterial therapy is carried out.