Secondary amenorrhea or recurrent pregnancy loss after instrumentation, suspected Asherman syndrome
Recommended: Saline Infusion Sonohysterography (SIS) or HSG is the preferred imaging study for secondary amenorrhea or recurrent pregnancy loss after instrumentation, suspected asherman syndrome. Intrauterine synechiae / adhesions, usually post-D&C.
Recommended study
Saline Infusion Sonohysterography (SIS) or HSG
Intrauterine synechiae / adhesions, usually post-D&C. Hysteroscopy is diagnostic and therapeutic.
If the default doesn't apply
Complex / fibrotic
Hysteroscopy
No contrast
Watch-outs
Pregnancy after lysis
Placenta accreta risk increased; monitor closely.
Pearls
- SIS shows filling defects / cavity distortion.
- AFS classification I-III based on extent of adhesion.
- Treatment: hysteroscopic adhesiolysis + IUD / estrogen for re-epithelialization.