Kakinuma T, Kakinuma K, Matsuda Y, Ohwada M, Yanagida K. Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report. World J Clin Cases 2022; 10(32): 11949-11954 [PMID: 36405260 DOI: 10.12998/wjcc.v10.i32.11949]
Corresponding Author of This Article
Toshiyuki Kakinuma, MD, PhD, Doctor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City 329-2763, Tochigi, Japan. kakinuma@iuhw.ac.jp
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Toshiyuki Kakinuma, Kaoru Kakinuma, Yoshio Matsuda, Michitaka Ohwada, Kaoru Yanagida, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara-City 329-2763, Tochigi, Japan
Author contributions: Kakinuma T conceived, designed, and performed the analysis, and wrote the paper; all authors collected and contributed data/analysis tools; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying image.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Doctor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City 329-2763, Tochigi, Japan. kakinuma@iuhw.ac.jp
Received: July 13, 2022 Peer-review started: July 13, 2022 First decision: September 5, 2022 Revised: September 27, 2022 Accepted: October 9, 2022 Article in press: October 9, 2022 Published online: November 16, 2022 Processing time: 117 Days and 14.9 Hours
Abstract
BACKGROUND
Asherman’s syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix, resulting in inability to carry a pregnancy to term, placental malformation, or infertility. We present the case of a 40-year-old woman diagnosed with Asherman’s syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation, intrauterine device insertion, and Kaufmann therapy.
CASE SUMMARY
A 40-year-old woman (Gravida 3, Para 0) arrived at our hospital for specialist care to carry her pregnancy to term. She had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease, followed by chemotherapy. She subsequently became pregnant twice, but both pregnancies resulted in spontaneous miscarriages during the first trimester. Her menstrual periods were very light and of short duration. Hysteroscopic adhesiolysis with concurrent laparoscopy was performed, and Asherman’s syndrome was diagnosed. The uterine adhesions covered the area from the internal cervical os to the uterine fundus. Postoperative Kaufmann therapy was administered, and endometrial regeneration was confirmed using hysteroscopy. She became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of gestation. The postpartum course was uneventful, and she was discharged on postoperative day 7.
CONCLUSION
Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery, without complications.
Core Tip: Adhesion dissection under laparoscopic monitoring in Asherman's syndrome is useful not only for avoiding the risk of surgical complications such as uterine perforation, but also for intraperitoneal observation to investigate the cause of infertility. Kaufman therapy and the use of an indwelling intrauterine device were useful for preventing postoperative recurrence of intrauterine adhesions.
