جستجوی مقالات مرتبط با کلیدواژه « سندرم آشرمن » در نشریات گروه « پزشکی »

Intrauterine adhesion is a condition that can lead to infertility, amenorrhea, repeated abortion in the patient, and the treatment of these patients is usually associated with many challenges. The present study was performed with aim to compare the effect of two different doses of estrogen to prevent the recurrence of adhesions after hysteroscopic lysis in Asherman's syndrome.

This randomized controlled clinical trial study was performed on 30 patients with moderate and severe Asherman's syndrome in Imam Reza Hospital of Mashhad, 2017-2021. Patients underwent hysteroscopy to remove adhesions. For all patients, an intrauterine balloon was placed after the operation and then they were treated with estrogen for 30 days and medroxyprogesterone 10 mg daily for the last 10 days. Patients were randomly assigned to two groups of estrogen 2.5 mg and 5 mg daily. After the end of the treatment period, with hysteroscopy again, the state of the uterine cavity was checked and the response to the treatment was compared in terms of the return of adhesions and its intensity in the two groups. Data were analyzed using SPSS software (version 26) and Shapiro-Wilk and Mann-Whitney U statistical tests. P<0.05 was considered statistically significant.

The most common cause of Asherman in the 2.5 mg group was curettage (60%) and in the 5 mg group, other surgeries (60%). The two groups had no statistically significant difference in terms of confounding variables including age, cause of Asherman's disease and severity of adhesions (p=0.714). In examining the response to treatment, there was no statistically significant difference between the two groups in terms of adhesion severity in repeated hysteroscopy (p=0.858) and response to treatment (p=0.714).

For the prevention of recurrence of intrauterine adhesions (Asherman's syndrome) after hysteroscopic lysis of adhesions, the dose of 2.5 mg of Conjugated estrogen was as effective as the dose of 5 mg of estrogen.

Asherman's syndrome (AS) is an acquired and refractory disorder in women whose treatments are currently limited and ineffective. Stem cell-based therapies have recently become a new way to treat tissue damage and fibrosis. Cell therapy is now proposed as a new strategy for the reconstruction and management of endometrial disorders such as Asherman syndrome. The present study was performed aimed to review a summary of research showing the key role of cell therapy in the treatment of intrauterine disorders and adhesions.

In this review article, the articles related to the role of stem cells in the prevention and treatment of intrauterine adhesions were searched in databases of ISI, Google scholar, PubMed, Scopus and SID using the keywords of Asherman's syndrome, Intrauterine adhesions, and Stem cell therapy without time limitation. At the end, the input data were qualitatively analyzed.

Studies show that stem cell transplants come from a variety of sources, including bone marrow (BMCS), adipose tissue (ASC), amniotic fluid (AFSC), placenta (PSC), and menstrual blood (MenSC) that regenerates the uterine endometrium and restores fertility in Asherman syndrome. Studies have shown that transplantation of BMSCs and MenSCs, not only in animal studies but also in clinical studies, has led to the regeneration and formation of damaged endometrial tissue structure. In preclinical models, Adipose tissue-derived stem cells (ASCs), amniotic fluid-derived stem cells (AFSCs) and placenta-derived stem cells (PSCs) have been able to play an effective role in regenerating and strengthening the uterine endometrium by increasing epithelial thickness and reducing collagen secretion and deposition.

Use of stem cells can play an important role in the regeneration and formation of endometrial tissue of the uterus and thus has beneficial effects in prevention and treatment of intrauterine adhesions.

Asherman syndrome (uterine adhesion) occurs due to injuries to the basal layer of endometrium that is usually caused following surgeries of uterine such as curettage and myomectomy. In the next pregnancy, obstetrical complications such as abortion, placenta pravia and acreta may be increased.

In this study, a case of amenorrhea after one uncomplicated caesarean section is reported. She had spontaneous pregnancy after treatment with three times histroscopy. In the next pregnancy, she developed severe adhesion to the myometrium, resulting in severe hemorrhage and hysterectomy. 

Ashman syndrome may be caused following an uncomplicated cesarean section and may increase the chance of obstetrical complications in next pregnancy.