Intrauterine Adhesions (Asherman) Imaging Diagnosis

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Suspected adhesions · imaging pathway
   Transvaginal ultrasound/clinical suspicion of IUA — next step? (Intrauterine adhesions (IUA): basal endometrial injury (often postpartum/post-miscarriage curettage, infection, intrauterine surgery) → fibrous adhesions obliterating the cavity. Symptoms: hypomenorrhea/amenorrhea, infertility, recurrent loss, cyclic pain (with outflow obstruction).)
   • Initial screening/infertility workup (need to assess tubes/extent too) → Imaging screening (SIS/HSG)
   • Confirmation or planning treatment → Hysteroscopy · gold standard + treatment
2. [End] Imaging screening (SIS/HSG)
   Initial screening/infertility workup: TVUS (irregular/interrupted endometrial line, thin endometrium; 3D is better, alone has low sensitivity); SIS/saline infusion sonography (saline distension showing transcavitary fibrous bands, wall adhesions, sensitivity ~75%); HSG (filling defects/irregular contour, also assesses tubal patency; sensitivity ~75%/specificity ~95%/PPV ~50%, many false positives); add MRI for severe/complete obliteration. Abnormal → hysteroscopy to confirm.
3. [End] Hysteroscopy · gold standard + treatment
   Confirmation and treatment: hysteroscopy = gold standard (direct visualization of adhesions + simultaneous adhesiolysis); postoperative estrogen ± intrauterine barrier to prevent recurrence; prognosis by hysteroscopic grade (good with well-developed residual endometrial bands, limited reconstruction benefit when endometrium is minimal).

Source guidelines & references

• Intrauterine adhesion imaging (HSG/SIS/hysteroscopy, hysteroscopy gold standard)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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