Nama : Nur Rohmah Arsyad

No. Telepon : +6281379418405

Alamat : Kadipolo RT3 RW 35, Sendangtirto Utara, Berbah, Sleman, DI
Yogyakarta
Email : arsyad.rohmah@gmail.com

Ashermans Syndrome: A Case Series

Nur Rohmah Arsyad, Shofwal Widad

Obstetric and Gynecologic Department
Faculty of Medicine Gadjah Mada University-Sardjito Hospital

ABSTRACT
BACKGROUND
Ashermans syndrome is defined as intrauterine adhesion and/or endocervix with one or
more clinical manifestation. Clinical manifestation associated Ashermans syndrome
such as dismenorrhea, hipomenorrhea, infertility, recurrent pregnancy loss,
amenorrhea, dan history of abnormal placentation. On 2015, therere 7 cases were
diagnosed at dr. Sardjito Hospital Yogyakarta and had performed comprehensive
management. Comprehensive manajement of Ashermans syndrome including uterine
cavity restoration with operative procedure using hysteroscopy, prevention readhesion
with barrier methoodes (IUD or intrauterine balloon), and estrogen therapy to restore
endometrium function. Outcome was assesed to evaluate menstruation as indicator
functional endometrium. Second look hysterroscopy is needed to evaluate failed case or
recurrent case.
OBJECTIVE
To evaluate comprehensive management and outcome of Ashermans syndrome
patients at dr. Sardjito Hospital Yogyakarta.
METHODS
During 2015, clinical data of 7 cases that was diagnosed as Ashermans syndrome at dr.
Sardjito Hospital. Faculty of Medicine, Gadjah Mada University were studied
retrospectively from medical record.
RESULTS
The most common complaint of Ashermans syndrome is secondary amenorrhea found
in 5 cases (71%), dan 2 cases (29%) with hypomenorrhea. The risk factor from
curettage are 3 cases (43%), suspicious genital tuberculosis infection are 2 cases (29%),
1 case (14%) history of Cesarean section and compression B-Lynch suture, and 1 case
(14%) is idiopathic. Six patients (85,7%) success undergone hysteroscopy, 1 patient
(14,3%) undergone hysterotomy reconstruction cause of severe intrauterine adhession.
One patient undergone second look hysteroscopy. Severe stage was diagnosed on 4
(57%) patients, and 3 patients (43%) with moderate stage. Post opertion was inserted
intrauterine barrier for 2 weeks and gor estrogene therapy 4-6 mg/day for 3 cycle. After
comprehensive management, 5 patients (71%) succesfully return to menstrual cycle, and
2 patients (29%) still amenorrhea and prepared for second look hysteroscopy.
CONCLUSION
Comprehensive management on Ashermans syndrove giving good prognosis to
endometrial function return.
Key words: Ashermans syndrome, amenorrhea, hysteroscopy
 SINDROMA ASHERMAN: SERIAL KASUS
Nur Rohmah Arsyad, Shofwal Widad

KSM Obstetri dan Ginekologi RSUP dr. Sardjito/

Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

ABSTRAK
Latar belakang: Sindroma Asherman didefinisikan sebagai kondisi adhesi intrauterin
dan atau endoserviks disertai satu atau lebih manifestasi klinis. Manifestasi klinis terkait
sindroma Asherman adalah dismenorrhea, hipomenorrhea, infertilitas, recurrent
pregnancy loss, amenorrhea, dan riwayat plasentasi abnormal. Selama tahun 2015
didapatkan 7 kasus sindroma Asherman di RSUP dr. Sardjito Yogyakarta dan telah
menjalani manajemen komprehensif. Manajemen komprehensif meliputi tindakan
restorasi kavum uteri dengan prosedur operatif histeroskopi, pencegahan readhesi
dengan insersi barier, an terapi estrogen pasca tindakan. Luaran dinilai dengan
kembalinya menstruasi sebagai indikator kembalinya fungsi endometrium. Second look
hysterroscopy diperlukan pada kasus yang tidak respon ataupun terjadi rekurensi.
Tujuan: Mengevaluasi manajemen dan luaran pasien sindroma Asherman di RSUP dr.
Sardjito Yogyakarta.
Metode penelitian: Selama tahun 2015 terdiagnosis 7 kasus sindroma Asherman di
RSUP dr. Sardjito Yogyakarta. Data diperoleh secara retrospektif melalui rekam medis.
Hasil penelitian: Keluhan utama sindroma Asherman adalah amenorrhea sekunder
sebanyak 5 pasien (71%), dan 2 pasien (29%) dengan hipomenorrhea. Faktor risiko
yang didapatkan adalah tindakan kuretase sebanyak 3 pasien (43%), 2 pasien (29%)
dengan dugaan infeksi TB genital, 1 pasien (14%) dengan riwayat seksio sesarea
dengan B-Lynch suture, dan 1 pasien (14%) belum diketahui faktor risikonya. Enam
pasien (85,7%) sukses menjalani histeroskopi, 1 pasien (14,3%) menjalani rekonstruksi
dengan histerotomi karena adhesi intrauterin berat. Satu pasien menjalani second look
hysteroscopy. Sindroma Asherman derajat berat terdiagnosis pada 4 (57%) pasien, dan 3
pasien (43%) derajat sedang. Pasca operasi dilakukan pemasangan barier intrauterin
selama dua minggu dan mendapat terapi hormonal dengan estrogen 4-6 mg/hari. Setelah
manajemen komprehensif, 5 pasien (71%) berhasil menstruasi dan 2 pasien (29%)
dengan derajat berat belum menstruasi dan direncanakan second look hysteroscopy.
Kesimpulan:. Tatalaksana sindroma Asherman secara komprehensif memberi
prognosis yang baik terhadap kembalinya fungsi endometrium.
Kata kunci: Sindroma Asherman, amenorrhea, histeroskopi