Incidence, symptomatology and aetiological factors for Asherman's syndrome in Orlu, South East Nigeria

Abstract

Background: Asherman's syndrome is a significant cause of secondary amenorrhoea and infertility in Nigeria. It is largely preventable and safe practices will make it rare.

Aim: To determine the incidence, symptomatology and aetiological factors for Asherman's syndrome in Orlu, South East Nigeria.

Methods: A prospective assessment of the incidence, symptoms and aetiological factors for Asherman's syndrome in the 2 major health facilities in Orlu, Imo State, South East Nigeria between January 2005 and December 2008 using simple statistical  tables for analysis.

Results:  Out of the 1,626 new gynaecological cases seen within the study period, 62 of them were diagnosed as Asherman syndrome, giving an incidence rate of 3.8%. While 38 of them (61.3%) presented with secondary amenorrhoea, 20 (32.3%) presented with hypomenorrhoea. Forty-two (67.7%) of the cases had associated infertility.

Emergency Caesarean section was the single most common cause of Asherman's syndrome, responsible for 42.0% of cases, followed by manual removal of placenta (16.1%), dilatation and curettage (16.1%), puerperal sepsis (16.1%), myomectomy (6.5%) and another 6.5% independently due to intra-uterine fetal death (IUFD). In 2 cases (3.2%) no aetiological factors were identified.

Conclusion: The incidence of Asherman's syndrome in Orlu, South East Nigeria, is high. Majority of them present with secondary amenorrhoea and a high association with infertility. Caesarean section is the single most common cause of Asherman's  syndrome  in Orlu and many cases are associated with intra- uterine infections. It is recommended that safe obstetric and surgical practices will minimize the incidence of this preventable condition.

Keywords:  Asherman's syndrome, Incidence, Symptoms, Aetiological factors, Orlu, South East Nigeria