Endometrial Adhesions and IUDs (Lecture 5a)

What is Asherman's Syndrome? Name 1 symptom. What causes Asherman's syndrome?

Adhesions in the uterine cavity

Symptoms:

- normal/absent menses

- recurrent miscarriage

- infertility

- Trauma to basal layer causing scar tissue.

What are the diagnosis methods for Asherman's Syndrome? (HINT: 3)

HSG, SHG, hysteroscope

How do adhesions appear on SIS?

Adhesions appear as echogenic bands

How do adhesions appear on HSG?

Areas w/o contrast filling

What is the treatment for Asherman's Syndrome?

Removal or rupture of adhesions under direct visualization.

What does Asherman's syndrome look like sonographically?

- Hypoechoic breaks in endometrial continuity

- May calcify = echogenic

- W/ coexistent fibrosis = echogenic

- Endo pockets w/ loculated fluid

What are the 2 types of IUDs?

Copper or hormone-releasing (levonorgestrel) IUDs.

How does a copper IUD work?

Creates unfavorable environment for sperm and eggs

(does NOT release hormones)

Where should an IUD be placed?

Should be centered in the uterine body, with arms extending to uterine cornua

Name 3 IUD complications

Infection, perforation, malposition, incomplete removal.

When is a KUB x-ray used?

Used if IUD not found with ultrasound.

TRUE or FALSE: Plastic IUDs are harder to visualize on U/S than metal ones.

TRUE: Plastic IUDs are weaker reflectors, making them harder to visualize

What does an IUD look like sonographically?

- Sagittal = midline echogenic shaft / posterior shadowing

- Transverse = see shaft and wings

What does the retrieval string of an IUD look like sonographically?

Echogenic, linear structure

What decision is made in the first trimester for a pt who has an an IUD and is pregnant?

Decision to either remove IUD (risks pregnancy loss) or leave it (complications)

Complications:

- sepsis

- miscarriage/spontaneous abortion

- ectopic pregnancy

- fetal anomaly/demise

- premature delivery

- hemorrhage

- maternal death

What complications arise from an IUD in the 2nd trimester?

- More difficult to locate due to advancing gestational age

- Pain w/ distension of uterus/compression of IUD