Crystal Gold's List: Health & Fitness

• uterine synechiae

  • This is what Dr. Sumner diagnosed me with in the 3D ultrasound 9/8/09
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• adhesions restricted to only the cervix  or lower uterus may block menstruation

  • This is what we thought I had in March/April. During HSG test Dr. Henry was unable to get catheter in all the way. He took me to his office and numbed and dialated my cervix and felt some resistent and then got through. Then the HSG was successful. He believes there was a blockage at the cervical opening that he dislodged.
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• Pain during menstruation and  ovulation are also sometimes  experienced, and can be attributed to blockages.

  • This is what initially brought me to see Dr. Henry. I was having severe mentrual pain without any bleed. It was consistent with my cycle. I had all signs of ovulation also.
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• AS may result in infertility,  repeated miscarriages, pain from trapped blood, and future  obstetric complications

  • I have had the major pain and am very fearful of the infertility and repeated miscarriages.
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• There is evidence that left untreated, the obstruction of menstrual flow resulting from adhesions can lead  to endometriosis

  • This is another major fear for me.
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• 40% of patients who underwent repeated D&C for retained products of  conception after missed miscarriage or retained placenta developed AS
• The risk of AS also increases with the number of procedures: one study estimated  the risk to be 16% after one D&C and 32% after 3 or more D&Cs^[17], however  a single curettage often underlies the condition

  • I have had three D&Cs. One after incomplete miscarriage in 2005. One after M was born for retained placenta in July 06. One in July 09 due to miscarriage at 8 weeks.
    All three were performed by different doctors
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• adjunctive measures such as laparoscopy are used in conjuction with  hysteroscopy as a protective measure against uterine perforation

  • When first dicsussing Hysteroscopy as a potential answer, Dr. Henry said he would also take a camera through my belly button to avoid perforating the uterus.
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• As IUA frequently reform after surgery, techniques have been developed to  prevent recurrence of adhesions

  • After the most recent D&C, Dr Henry had me on Estrogen patches and then birth control as extra precaution. These seem to have not worked in preventing scarring again.
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• Premature delivery,^[25]  second-trimester pregnancy loss,^[26] and  uterine rupture^[27] are other  reported complications
• Patients who carry a pregnancy  even after treatment of IUA may have an increased risk of having abnormal  placentation including placenta accreta
• They may also develop incompetent  cervix where the cervix can no longer support the growing weight of the  fetus
• D&C could be performed under ultrasound guidance rather than as a blind  procedure

  • This is how Dr. Henry performed my D&C this time. He has been incredibly cautious.
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• the longer the period after fetal death following D&C, the more likely  adhesions may be to occur.^[

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