Hysteroscopic adhesiolysis using blunt spreading dissection technique in severe intrauterine adhesions with false passage

A 31 years old G3P1 (C-Section) A2 patient attended our hospital with a history of amenorrhea for 70 days following surgical termination of an 8w4d missed abortion with no cyclic lower abdominal pain. The patient had undergone two artificial cycle treatments after surgical termination, and there was no recovery with her menstruation. A hysteroscopy five days before this presentation in other hospital revealed severe intrauterine adhesions and a “tubular” uterine cavity. Pelvic examination revealed no abnormality. The urine pregnancy test was negative. An ultrasound scan revealed: C-Section scar, intrauterine adhesions and normal adnexa. The endometrium was marginally irregular, with uneven thickness and an interrupted III-line (Figure 1). Threedimensional (3D) color Doppler ultrasound showed the obliteration of the lower uterine segment with undetectable endometrium. The distance between the bilateral uterine horns was 18.3 mm (Figure 2). Preoperative diagnosis was “severe intrauterine adhesions (AFS score: 12)”.