A Study of Transvaginal Ultrasound in Asherman Syndrome

Objective: To determine the accuracy of transvaginal ultrasound in evaluation of uterine sonomorphology in nongestational amenorrhoea following curettage producers (Asherman Syndrome).

Methodology: The study population comprised all adult females in reproductive age group who presented with amenorrhea following a curettage procedure. Those with positive serum BHCG, and raised serum prolactin were excluded. Transabdominal (TAS) as well as transvaginal ultrasound (TVS) scan was carried out in all patients. Hystero-salpingography (HSG) was done in nearly all patients. Age, parity, indication for referral and curettage, duration of amenorrhea, frequency of curettage and previous menstrual and obstetric history, were obtained. Transvaginal scan findings were recorded and compared with HSG. Two patients came for a follow up after adhesionolysis.

Results: There were 17 patients in all with a mean age of 28.6 years, mean parity of 4.5 and mean amenorrhea duration of 5.5 months. Sixteen were primarily referred for evaluation of amenorrhea. Twelve had history of previous pelvic infection, 8 had previous menstrual irregularity and 15 had abortions. Repeat curettage was done in 09 patients. Trans abdominal ultrasound was positive in only one patient and transvaginal ultrasound was positive in all cases. Findings on the later examination included normal to thickened endometrium with heterogeneous echo texture, irregular outline, non-shadowing echogenic foci and sparse sub-endometrial vascularity. Calcification at endo-/myometrium junction was seen in one case on both techniques. The sensitivity of TVUS in diagnosing intra uterine adhesions was 92%, specificity 100%, positive predictive value 100% and negative predictive value 92%.

Conclusion: Transvaginal ultrasound shows accurate and specific uterine sono-morphologic features in traumatic amenorrhea and can be used as a reliable screening test.