Clinically significant uterine synechiae caused by transmural uterine incisions

The presence of clinically significant uterine synechiae, or Asherman's syndrome, is suspected when patients with a history of intrauterine instrumentation have new-onset menstrual disturbances, infertility, or recurrent pregnancy loss. Synechiae are typically attributed to instrumentation of a gravid or puerperal uterus. We present two cases in which uterine synechiae resulted from transmural uterine incisions. Hysteroscopic resection of adhesions bridging the anterior and posterior endometrial surfaces restored intrauterine anatomy. However, reproductive potential was still compromised. These cases highlight the need for increased vigilance to avoid iatrogenic intrauterine synechiae during repair of transmural uterine incisions.