Traumatic intrauterine adhesions

Introduction Intrauterine adhesion syndrome, any factors that cause endometrial destruction can cause uterine cavity adhesions, and intrauterine adhesions account for about 91% of pregnancy; common in abortion or spontaneous abortion. And postpartum hemorrhage curettage. Due to the softness of the uterus wall during pregnancy, it is not easy to control the depth when the curettage is performed, or the uterine cavity is excessively rubbed. When the suction is weak, the negative pressure is too large, and the lining of the endometrium is scraped off, resulting in postoperative intrauterine adhesions; 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

Because the uterine wall of the pregnancy is soft, it is not easy to control the depth when the curettage is performed, or the uterine cavity is excessively rubbed. When the suction is weak, the negative pressure is too large. The time is too long. The endometrial basal layer is scraped off to produce postoperative intrauterine adhesions; 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.

an examination

Related inspection

Hysteroscopy

Physical examination:

There is tenderness in the lower abdomen, rebound tenderness in severe cases, and even refused to press. Gynecological examination found that the size of the uterus is normal or slightly larger, softer, with obvious tenderness, sometimes with cervical pain; bilateral attachment examination, lighter normal, severe may have tenderness or thickening, or lumps and lumps: It is tender, and even after the puncture, it can extract dark red blood that does not coagulate, so it is called ectopic pregnancy-like syndrome.

Auxiliary inspection:

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 in the direction of the uterus. If the tissue is tough and the probe is not easy to insert, 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; muscle fiber adhesion is the most common, characterized by a thin layer of endometrium covering the surface with many gland openings; and 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, often overlaps the image of the uterus and the cervix. 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.

4. The basal body temperature is biphasic.

5, vaginal exfoliation cell examination has periodic changes.

6, serum progesterone, urine gestationaldiol determination has periodic changes, and ovulation.

7, cervical mucus crystals can appear as fern-like crystals and ellipsoids.

8, hormone therapy test estrogen, progesterone or artificial cycle treatment, repeated withdrawal cycles without withdrawal.

9. Hysteroscopy In recent years, hysteroscopy has been used as a method for diagnosing and treating uterine cavity adhesions.

Differential diagnosis

Differential diagnosis:

(a) ectopic pregnancy

When uterine adhesions occur in amenorrhea and lower abdominal pain, it 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.

(two) pelvic infection

If abortion occurs after artificial abortion or curettage, it 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. The abdominal pain caused by the adhesion of the uterus is periodic, spastic uterine contraction pain, and there is no fever, white l cells and so on.

(three) endometriosis

Although the disease is caused by dysmenorrhea, it is also periodic abdominal pain. And progressive exacerbation, but the blood discharge is smooth, the symptoms of abdominal pain are not alleviated after menstrual blood flow; and the abdominal pain caused by uterine cavity adhesion is obstructive dysmenorrhea, and the symptoms of the menstrual blood can be relieved or even disappeared after dilating the cervix. Can also be identified from the history of the disease, endometriosis is often infertility, and official adhesions occur after artificial abortion.

(D) early pregnancy, palace, curettage, amenorrhea

Early pregnancy should also be ruled out. There is no history of abdominal pain in early pregnancy. There is often a history of pregnancy reaction. The increase in uterus is often consistent with the pregnancy month. Positive urine test is often helpful in diagnosis.

(5) Amenorrhea

After the intrauterine adhesions, 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.

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