Review Note

A 28-year-old patient complains of amenorrhea after dilation and curettage (D&C) for postpartum bleeding. She denies any other complaints and did not require a blood transfusion at the time of her postpartum bleed. Which of the following is the most likely diagnosis?

• gonadal dysgenesis
• Sheehan syndrome
• Kallmann syndrome
• Mayer-Rokitansky-Kister-Hauser syndrome 
• Asherman syndrome
  

Asherman syndrome refers to the presence of intrauterine scarring (synechiae). The most common cause of this disorder is uterine curettage for postpartum hemorrhage or abortion. It may also accompany myomectomy, metroplasty, cesarean section, uterine infection due to intrauterine device use, tuberculosis, and schistosomiasis. Intrauterine synechiae are diagnosed either by injecting radiographic dye into the uterus under fluoroscopic view (hysterosalpingography) or by directly visualizing the uterine cavity (hysteroscopy). The latter technique may also be used therapeutically to lyse adhesions. Approximately 70% of patients treated for Asherman syndrome have a subsequent successful pregnancy. Many experience difficulties with placental-uterine separation after birth, leading to an increased risk of postpartum hemorrhage. Gonadal dysgenesis, M-R-K-H syndrome and Kallman are congenital anomalies that would have presented a pregnancy. Sheehan syndrome is rare in the setting of postpartum hemorrhage unless there was hypovolumeic shock that would have been treated with transfusion.

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