REFERAT

Asherman Syndrome
Oleh:
Ridha Rahmatania (I11112027)
Pembimbing:
dr. Vidia Sari, Sp.OG

Kepaniteraan Klinik Mayor

Stase Ilmu Kesehatan Wanita
RSUD Sultan Syarif Mohamad
Alkadrie
2018
 PENDAHULUAN
perlekatan – perlekatan
Sindrom Asherman (adhesi) dalam rongga
uterus

gangguan
menstruasi
luka (jaringan parut) di
endometrium

infertilitas

19% perempuan yang 42% orang mengalami

dikuret setelah mengalami IUAs derajat sedang
keguguran hingga berat
Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Williams gynecology. 2nd
Edition. New York: McGraw Hill Medical. 2012; 460-477
 PENDAHULUAN (2)
Intrauterine
tahun 1894 Heinrich Fritsch
Adhesions (IUAs)

gejala berupa
Joseph gangguan
tahun 1948
Asherman menstruasi, nyeri
panggul, dan
infertilitas

Asherman
Syndrome

Hooker AB, de Leeuw R, van de Ven PM, Bakkum EA, Thurkow AL, Vogel NEA. Prevalence of intrauterine adhesions after the
application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term
outcomes of a multicenter, prospective randomized controlled trial. Fertil Steril. 2017 May;107(5):1223-1231
 DEFINISI
• Sindrom Asherman  suatu keadaan di mana
dalam rongga uterus terdapat perlekatan –
perlekatan (adhesi) yang menyebabkan distorsi
anatomis ruang uterus, akibat adanya luka
(jaringan parut) di dalam rongga uterus, yaitu di
endometrium
• Gejala klasiknya  gangguan menstruasi
(amenorrhea atau oligomenorrhea), infertilitas,
nyeri panggul

• Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Williams
gynecology. 2nd Edition. New York: McGraw Hill Medical. 2012; 460-477.
 Epidemiologi
15% incidence of IUA
formation after suction dilation and curettage
1 (D&C) for management of spontaneous abortion
(SAB)

The risk increases for patients undergoing

2 repeated procedures for bleeding or repeated
elective termination of pregnancies

It is found in 1.5% of women evaluated with a

3 hysterosalpingogram (HSG) for infertility,

Asherman syndrome was found in between 5

4 and 39% of women with recurrent miscarriage

• Salazar, Isaacson K, Morris S. A Comprehensive review of Asherman’s syndrome: causes, symptoms and treatment options. Curr
Opin Obstet Gynecol 2017, 29:000–000
• Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature.
Reproductive Biology and Endocrinology 2013, 11:118
 Etiologi
• IUAs form secondary to
injury of the basalis layer,
as can occur with any
surgery performed on the
uterine cavity.
• Fibrous tissue forms
wherein there is a loss of
stroma, and this fibrin
production creates tissue
bridges between the walls
of the uterine cavity
resulting in adhesion
formation

• Salazar, Isaacson K, Morris S. A Comprehensive review of Asherman’s syndrome: causes,

symptoms and treatment options. Curr Opin Obstet Gynecol 2017, 29:000–000
• Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Williams
gynecology. 2nd Edition. New York: McGraw Hill Medical. 2012; 460-477.
 Faktor Risiko

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome:

a review of literature. Reproductive Biology and Endocrinology 2013, 11:118
 KLASIFIKASI
American Society for Reproductive Medicine
(ASRM) intrauterine adhesions classification
 DIAGNOSIS
• In women with suspected Asherman
syndrome, physical examination frequently
fails to reveal abnormalities

AAGL Elevating Gynecologic Surgery Gynecological Surgery (2017) 14:6

 HISTEROSKOPI

Gambaran perlekatan di rongga uterus terlihat melalui histeroskopi

• Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Williams
gynecology. 2nd Edition. New York: McGraw Hill Medical. 2012; 460-477.
 Hysterosalpingography

Hysterosalpingogram findings. These images are digitally reversed, causing the radiopaque
contrast to appear black against a radiolucent background.
A. Normal hysterosalpingogram. Radiopaque dye fills the uterine cavity and spills from both
fallopian tubes into the peritoneal cavity. The dye catheter is seen directly beneath the
endometrial contour.
B. Asherman syndrome. Contrast dye fills a small and irregularly shaped endometrial cavity,
often described as having a “moth-eaten” appearance.
Sonohysterography
 Management and treatment
of Asherman syndrome
Treatment

Re-adhesion prevention

Restoring normal endometrium

Post-operative assessment

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a

review of literature. Reproductive Biology and Endocrinology 2013, 11:118
 Penanganan Adhesi

• Hysteroscopic lysis of adhesions

gold standard
• Non hysteroscopic methods 
laparotomy, hysterotomy, and
subsequent blunt dissection

• Salazar, Isaacson K, Morris S. A Comprehensive review of Asherman’s syndrome: causes,

symptoms and treatment options. Curr Opin Obstet Gynecol 2017, 29:000–000
 Restorasi Endometrium
• terapi hormonal; kombinasi 2 mg
micronized oestradiol dua kali sehari
selama 30 – 60 hari dengan
medroxyprogesterone acetate 10 mg
setiap hari selama 5 hari terakhir terapi
estrogen.
• Stem cell

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome:

a review of literature. Reproductive Biology and Endocrinology 2013, 11:118
 Pencegahan Adhesi
Berulang
• intrauterine device (IUD)
• Intrauterine balloon stent
• Foley catheter
• Hyaluronic acid

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome:

a review of literature. Reproductive Biology and Endocrinology 2013, 11:118
 Evaluasi Post-Operatif

• ultrasonografi (USG)
• Histeroskopi
• HSG  dapat digunakan untuk
menilai patensi tuba dan
kondisi rongga uterus.

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome:

a review of literature. Reproductive Biology and Endocrinology 2013, 11:118
 Prognosis
• Keberhasilan menstruasi kembali  >95%
• Pasien dengan AS berisiko tinggi mengalami
komplikasi kehamilan. 19% mengalami
abortus spontan, kelahiran prematur di
antara pasien dengan derajat sedang-
berat
• 14% mengalami plasenta abnormal
• 8% mengalami perdarahan pasca
persalinan
• Rekurensi IUA  29%

• Salazar, Isaacson K, Morris S. A Comprehensive review of Asherman’s syndrome: causes,

symptoms and treatment options. Curr Opin Obstet Gynecol 2017, 29:000–000
 Kesimpulan
• Sindrom Asherman  suatu keadaan di mana
dalam rongga uterus terdapat perlekatan –
perlekatan (adhesi) yang menyebabkan distorsi
anatomis ruang uterus, akibat adanya luka
(jaringan parut) di dalam rongga uterus, yaitu di
endometrium
• Gejala  gangguan menstruasi (amenorrhea atau
oligomenorrhea), infertilitas, nyeri panggul
• 15% incidence of IUA formation after suction
dilation and curettage (D&C) for management of
spontaneous abortion(SAB)
• Gold standard diagnosis  histereskopi
• Strategi penatalaksanaan AS  penanganan
adhesi, pencegahan adhesi berulang, restorasi
endometrium ke kondisi normal, dan evaluasi post-
operatif
• Rekurensi IUA  29%
• Keberhasilan menstruasi kembali  >95%
• Pasien dengan AS berisiko tinggi mengalami
komplikasi kehamilan
TERIMA KASIH