Critical Care Obstetrics and Gynecology

Figure 1: Asherman's syndrome is an uncommon, acquired, gynecological disorder characterized by changes in the menstrual cycle. Patients experience reduced menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), and, in many instances, infertility. Most patients with Asherman’s syndrome present with sparse or absent menstrual blood flows. In a few instances, the menstrual cycle may be normal. In some instances, the affected individual may experience an interrupted menstrual blood flow with substantial pain. This may occur as a result of blockage of the cervix (the neck of the uterus) by adhesions. Recurrent miscarriages and/or infertility may also be signs of this syndrome. Unless the physician is careful, the diagnosis of Asherman's syndrome may be needlessly overlooked. A simple X-ray of the uterus with a small tube placed in the cervix is usually diagnostic. However, many physicians will, to save time, use a small balloon catheter placed in the uterus. The latter technique will overlook some cases of this syndrome. The gold standard for diagnosis uses a hysteroscope that pictures the interior of the uterus directly. However, many physicians will, to save time, use a small balloon catheter placed in the uterus. The latter technique will overlook some cases of this syndrome. The gold standard for diagnosis uses a hysteroscope that pictures the interior of the uterus directly.