Synechia are adhesions between organs and can occur in the abdominal cavity, in the serous cavities of the pleura, in the pericardium, in girls between the labia, in boys between the head of the penis and the foreskin. This phenomenon can be congenital or acquired and occurs for a variety of reasons.
The term “sinechia”, applicable to women, means pathological adhesions of adjacent surfaces inside the uterus, resulting from mechanical impact during abortion and after childbirth on the basal layer of tissue lining the uterus. Intrauterine synechia often occurs after surgical interventions, the use of an intrauterine device as a contraceptive, the introduction of various drugs into the uterus.
Infection is not the primary factor in the occurrence of intrauterine adhesions, but complications always arise when an infection attaches to a damaged endometrium. Adhesions are most likely in women with missed pregnancy. This is explained by the fact that the remnants of the placenta contribute to the activation of connective tissue cells (fibroblasts), resulting in the formation of collagen. The cause of the formation of synechia inside the uterus is chronic endometritis.
The fusion of the uterine cavity causes pain in the lower abdomen, making it difficult for the discharge of secretions during menstruation. Sometimes, some women may experience complete infection of the uterine cavity or cervical canal. In this case, menstruation completely stops.
According to the histological structure there are:
light synechia – in the form of a film, easily dissected, consist of the endometrium;
medium synechia – consist of the endometrium, bleed during dissection, fibromuscular;
severe synechia – connective tissue, dissected with difficulty due to high density, do not bleed;
Unions inside the uterus are divided according to the degree of prevalence:
I degree – thin adhesions, cover no more than 1/4 of the organ cavity, the bottom and mouths of the pipes are not affected;
II degree – affect 1/4 to 3/4 of the uterine cavity, the walls do not stick together, only adhesions are formed, the bottom and mouth of the tubes are not completely closed;
III degree – more than 3/4 of the cavity of the female reproductive organ is covered.
The higher the degree of adhesive process, the more serious the impact on a woman’s health, they are accompanied by menstrual dysfunction or lack of menstruation, which ultimately leads to infertility or difficulties in bearing a fetus.
If infection is observed in the lower part of the uterine cavity, then an accumulation of blood (hematometer) may be found in the upper part.
Significant infection of the uterine cavity affects the normal functioning of the internal mucous membrane (endometrium), which entails the difficulty of attaching the ovum. It follows from this that pregnancy in the case of intrauterine synechia is a high risk, with possible complications during and after childbirth.
To date, examination of women with suspected intrauterine adhesions does not have a single algorithm. Experts believe that diagnosis should be carried out using hysteroscopy, in which whitish strands of various lengths and densities are usually visible, which do not contain blood vessels and significantly reduce the space of the organ. Synechia can close the entrance to the cervical canal of the cervix, which means that it makes its cavity inaccessible for the further development of the embryo.
If there are doubts after the diagnosis by hysteroscopy, then they resort to a more effective method – hysterosalpingography. This type of study helps to determine the degree of union and the extent of adhesions. Usually, with the help of this diagnostic tool, adhesions can be detected, expressed as single or multiple filling defects that have an irregular shape and different sizes. Multiple synechiae of high density divide the uterus into chambers, which are interconnected by ducts. Treatment of intrauterine synechia is limited only by dissection of the remaining endometrium with a hysteroscope. The operation takes place without injury. After that, over time, the normal menstrual cycle is restored and the ability of the female body to fertilize returns. The effectiveness of the procedure depends on the type of adhesions and the degree of spread. In order to avoid recurrence, various hormonal preparations are introduced into the uterine cavity. Timely detection of the disease, early diagnosis and destruction of minor adhesions without injury is the key to happy motherhood. Before deciding on the birth of a child, it is necessary to undergo a thorough examination.
It is better to identify any pathologies before pregnancy. Every woman should remember the need for regular visits to a gynecologist, since advanced stages are difficult to treat, and no one can guarantee the absence of recurrences of the disease.