intrauterine adhesions
Introduction
Introduction Any cause of endometrial destruction can cause uterine cavity adhesions, and intrauterine adhesions account for about 9l% of pregnancy, which is common in abortion or spontaneous abortion. And postpartum hemorrhage curettage. Because the uterine wall of pregnancy is soft, it is not easy to control the depth when curettage, or excessive sputum curettage, the negative pressure is too large when taking the palace, the time is too long. The endometrial basal layer is scraped off, resulting in postoperative intrauterine adhesion, tip, Repeated in and out of the cervix, irregular expansion of the cervix can aggravate the injury, increase the chance of postoperative intrauterine adhesions, non-pregnancy caused by intrauterine adhesions accounted for about 9%, such as endometrial tuberculosis, uterine fibroids excavation , diagnostic curettage, etc.
Cause
Cause
The main causes of intrauterine adhesions are:
1. History of uterine operation
(1) Pregnancy factors: uterine surgery related to pregnancy such as early pregnancy negative pressure suction surgery, mid-pregnancy clamp surgery, mid-pregnancy induction of curettage, postpartum hemorrhage curettage and spontaneous abortion curettage. This may be due to the fact that the lining of the intima of the uterus is more likely to be damaged, causing the walls of the uterus to stick to each other and form a permanent adhesion.
(2) non-pregnancy factors: uterine fibroids removal surgery (into the uterine cavity), uterine submucosal fibroids by hysterectomy, uterine mediastinal resection, double uterine orthopedics, etc. destroyed the basal layer of the intima, making the uterus The muscle layer is exposed to the uterine cavity, leading to adhesion of the anterior and posterior wall of the uterine wall.
2. Surgical inflammatory factors
Intrauterine infection of uterine tuberculosis, postmenopausal senile endometritis, secondary infection after intrauterine operation, infection during puerperium, secondary infection after placement of intrauterine device.
3. Human factors
Artificially destroy the basal layer of the endometrium, causing intrauterine adhesions. Such as: endometrial electrical resection, intrauterine microwave, cryotherapy, chemical drug treatment and local radiotherapy.
4, endometrial damage during curettage for various reasons
Such as repeated curettage, which is very easy to damage the basal layer, the intrauterine adhesion caused by this cause is called the most common damage occlusion, so the obstetrician should be moderate in the curettage, women of childbearing age should implement Good contraceptive measures to avoid abortion, especially the first fetus may cause infertility after intrauterine adhesions.
Examine
an examination
Related inspection
Uterine fallopian tube uterus and accessory examination endometrial biopsy X-ray lipiodol uterine hysteroscopy
1, uterine probe examination General uterus probe inserted into the cervix about 1-3 cm, there is a sense of resistance, about 2 cm is the most common. The resistance can vary according to the adhesion tissue. Only the endometrial adhesion probe is easy to insert. When the muscle layer is stuck, the probe should be inserted with a little force according to the direction of the uterus. If the tissue is tough and hard, the probe is not easy to insert, and it should not be blind. Use force. So as not to cause uterine perforation. After the probe enters the uterine cavity, the fan can be swept left and right to sweep the official cavity to test the size of the uterine cavity and the extent of adhesion. A severely adherent person may feel a narrow tube in the uterine cavity, and the probe has a small range of motion or cannot be penetrated at all.
2, hysteroscopy can understand the presence or absence of intrauterine adhesions, and determine the location, extent, extent and adhesion of adhesions. The characteristics of adhesion in each group are: endometrial adhesion is very similar to the surrounding endometrium, and muscle fiber adhesion is the most common. It is characterized by a thin layer of endometrium covering the surface with many gland openings, while connective tissue adhesion is the surface. No endometrial formation.
3, uterine lipiodol angiography is characterized by:
(1) There may be one or more contours in the uterine cavity, sharp edges, abnormal shape, irregular filling defect shadows, and not subject to the pressure or amount of contrast agent injected.
(2) The local edge of the uterine cavity is not neat.
(3) A fine mesh-like blood vessel image often appears. This is because the pressure of injecting iodized oil during the contrast is too large, so that the lipiodol enters the uterine blood vessel from the peeling surface.
(4) Some uterus that adheres to the uterus, with high flexion or flexion, the image of the uterus and the cervix often overlaps and the uterus is olive-shaped. In this case, the cervical canal can be used to pull the cervix to stretch the uterus, and the uterus image can be changed from olive to triangle. In order to prevent chronic inflammation caused by oil plugs and oils, water-soluble contrast agents can also be used. Mild adhesion can be separated by contrast.
Diagnosis
Differential diagnosis
Differential diagnosis of intrauterine adhesions:
(A) ectopic pregnancy uterine adhesions: the occurrence of amenorrhea and lower abdominal pain, should be differentiated from ectopic pregnancy. The former has a history of induced abortion or curettage, abdominal pain is mainly periodic, although the lower abdomen has tenderness or rebound pain, but no symptoms such as internal bleeding and shock, uterine probe or hysteroscopy can be diagnosed, when the blood is detected After the circulation is smooth, the symptoms of abdominal pain are alleviated or disappeared. Patients with ectopic pregnancy often have symptoms and signs of internal bleeding after abdominal pain, and more can be diagnosed after puncture.
(B) pelvic infection: if induced by pelvic infection after artificial abortion or curettage, can also cause lower abdominal pain, but the abdominal pain caused by infection is persistent dull pain, no history of periodic attacks, and fever, leukocytosis and other infections which performed. The abdominal pain caused by the adhesion of the uterus is periodic, spastic uterine contraction pain, and there is no fever, leukocytosis and so on.
(C) endometriosis: the disease caused by dysmenorrhea is also periodic abdominal pain. And progressive exacerbation, but the menstrual blood discharge is unobstructed, the symptoms of abdominal pain are not alleviated after menstrual bleeding, and the abdominal pain caused by uterine cavity adhesion is obstructive dysmenorrhea. After dilating the cervix, the symptoms of menstrual blood can be relieved immediately or even disappeared. Can also be identified from the history of the disease, endometriosis is often infertility, and official adhesions occur after artificial abortion.
(D) early pregnancy, uterine curettage, curettage after surgery: should also rule out early pregnancy, early pregnancy generally no history of abdominal pain, often have a history of pregnancy reaction uterus enlargement is often consistent with the pregnancy month, urine pregnancy test is often helpful for diagnosis.
(5) Amenorrhea in the amenorrhea: only simple amenorrhea without abdominal pain or abdominal pain is not obvious, it needs to be differentiated from pituitary or hypothalamic amenorrhea, premature ovarian failure. Amenorrhea caused by adhesion of the uterine cavity, menstruation can not be recovered after treatment with progesterone, estrogen or artificial cycle, and basal body temperature measurement, cervical mucus crystallization and vaginal exfoliation smear examination showed normal ovarian function.
