الفهرس 
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Abstract
The universal incidence of IUAs, or Ashennan’s
syndrome, is steadily increasing. The increasing
use of hysteroscopy as a diagnostic tool in gynecology
has also shown that IUAs are of more concern than
previously recognized.
The main offender in the etiology of the disorder is
trauma to a pregnant uterus especially curettage after
delivery or abortion. The role of infection especially
genital tuberculosis also can not be ignored.
Intrauterine adhesions are not uncommon and the
clinical picture and degree of adhesion fonnation are
variable, ranging from few intra-cervical adhesions to
complete obliteration of the uterine cavity.
The diagnosis of the condition is suggested by the
history, development of amenorrhea or hypomenorrhea
and confirmed by hystersalpingography or hysteroscopy.
The history usually is of secondary amenorrhea,
infertility and possibly cyclical pain or menstrual
abnormalities. These symptoms are often preceded by
postpartum or postabortal curettage or multiple
curettages.
Pregnancy when achieved in a patient with
intrauterine adhesions may be complicated by premature
labor, placenta previa, or placenta accreta.
III this study two hundred patients were subjected to
diagnostic hysteroscopic examination four to six weeks
lollowing curettage for first trimester spontaneous
abortion. The overall incidence of intrauterine adhesions
detected was 17%.
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The vast majority of intrauterine adhesion cases
(15.5%) were of a mild degree where less than onefourth
of the uterine cavity was involved with thin or
filmy adhesions easily broken even by the sheath of the
hysteroscope. Only 1.5% was of a moderate degree
where one to three-fourths of the uterine cavity was
involved with adhesions only and no agglutination of the
walls. We could not detect any case with severe
adhesions where more than three fourths of the uterine
cavity would be involved with thick bands or
agglutination of the walls.
It has been found that the incidence of intra uterine
adhesions following curettage for spontaneous abortion
increases with the number of abortions the patient has
suffered, IUAs were found in 11.8% of cases that
suffered only one abortion, 22.9% of cases that suffered
two abortions and 32% of patients who suffered three or
more abortions.
The severity of intrauterine adhesions also
increases with the number of abortions the patient has
suffered. This was shown by the observation that all
cases of IUAs following one abortion were of mild
degree. After two abortions only 2.1% showed moderate .
adhesions. After three or more abortions 8% showed
moderate adhesions.
It is to be stressed that curettage of a gravid uterus
should be performed only when there is dire necessity;
and if unavoidable, the manipulation must be carried out
with the greatest care and apprehension.
It is also stressed that whenever amenorrhea,
hypomenorrhea and! or infertility is manifest subsequent
to uterine trauma, the existence of IUAs should be
strongly suspected.