Severe Asherman after postpartum curettage — management and counselling station

Management and communication station: severe Asherman after postpartum curettage. Tests the diagnostic pathway, severity grading, hysteroscopic adhesiolysis with a mandatory prevention plan, the evidence for adjuvants (gel, estrogen, barriers), second-look strategy, refractory-disease options, and honest counselling on reproductive prognosis and obstetric surveillance. Includes assessor key and marking domains.

Prompt

A 31-year-old G2P1 presents with secondary amenorrhoea and subfertility for 14 months since a postpartum curettage for retained products of conception after an emergency caesarean. Her endocrine screen is normal and she is not pregnant. A 3D ultrasound shows a thin, irregular endometrium with suspected adhesions. She and her partner are desperate for a second child. You are the fertility clinic registrar; the consultant is available.

Station brief

Format. Management and communication station, approximately 12 minutes. You are the fertility clinic registrar. A clinic nurse and a counsellor are available; the consultant is contactable. The assessor will play the patient and her partner and feed you their questions and concerns.^[1]

Candidate instruction. Establish the diagnosis and severity, plan the hysteroscopic adhesiolysis with a mandatory prevention strategy, sequence the second-look and refractory-disease options, and counsel the couple honestly on reproductive prognosis and obstetric surveillance. Demonstrate the counselling out loud.^[1]^[2]

References7Show

[1]Ma H, Yang M A System Review of Pathophysiology, Diagnosis, and Clinical Management of Intrauterine Adhesions Obstetrical & gynecological survey, 2026.PMID 42241335
[2]Munro MG, Salazar CA, Bhagavath B, Emanuel MH, Huddleston HG, Sobti D, Jaiswal AK, Gamburg R, Kumar J, Martin C, Hooker AB The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyses Human reproduction update, 2025.PMID 40914965
[3]Luo Y, Sun Y, Huang B, Chen J, Xu B, Li H Effects and safety of hyaluronic acid gel on intrauterine adhesion and fertility after intrauterine surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials American journal of obstetrics and gynecology, 2024.PMID 38191020
[4]Feng L, Sun Y, Zhang S, Qian Y, Fang S, Yang B, Xu L, Li J, Niu Y, Zhang S, Zhang L, Chen J A novel intrauterine estrogen-releasing system for preventing the postoperative recurrence of intrauterine adhesion: a multicenter randomized controlled study BMC medicine, 2024.PMID 39285313
[5]Liu L, Huang X, Xia E, Zhang X, Li TC, Liu Y A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis Human fertility (Cambridge, England), 2019.PMID 29504823
[6]Hooker AB, de Leeuw RA, Twisk JWR, Brölmann HAM, Huirne JAF Reproductive performance of women with and without intrauterine adhesions following recurrent dilatation and curettage for miscarriage: long-term follow-up of a randomized controlled trial Human reproduction (Oxford, England), 2021.PMID 33320197
[7]Hou Z, Yang T, Xu D, Fu J, Tang H, Zhao J, Zhang Q, Chen J, Qin Q, Li W, Chen H, Li H, Guo L, Xu B, Li Y hUC-MSCs loaded collagen scaffold for refractory thin endometrium caused by Asherman syndrome: a double-blind randomized controlled trial Stem cells translational medicine, 2025.PMID 40371958

Severe Asherman after postpartum curettage — management and counselling station

Station brief

References7Show

[1]Ma H, Yang M A System Review of Pathophysiology, Diagnosis, and Clinical Management of Intrauterine Adhesions Obstetrical & gynecological survey, 2026.PMID 42241335
[2]Munro MG, Salazar CA, Bhagavath B, Emanuel MH, Huddleston HG, Sobti D, Jaiswal AK, Gamburg R, Kumar J, Martin C, Hooker AB The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyses Human reproduction update, 2025.PMID 40914965
[3]Luo Y, Sun Y, Huang B, Chen J, Xu B, Li H Effects and safety of hyaluronic acid gel on intrauterine adhesion and fertility after intrauterine surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials American journal of obstetrics and gynecology, 2024.PMID 38191020
[4]Feng L, Sun Y, Zhang S, Qian Y, Fang S, Yang B, Xu L, Li J, Niu Y, Zhang S, Zhang L, Chen J A novel intrauterine estrogen-releasing system for preventing the postoperative recurrence of intrauterine adhesion: a multicenter randomized controlled study BMC medicine, 2024.PMID 39285313
[5]Liu L, Huang X, Xia E, Zhang X, Li TC, Liu Y A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis Human fertility (Cambridge, England), 2019.PMID 29504823
[6]Hooker AB, de Leeuw RA, Twisk JWR, Brölmann HAM, Huirne JAF Reproductive performance of women with and without intrauterine adhesions following recurrent dilatation and curettage for miscarriage: long-term follow-up of a randomized controlled trial Human reproduction (Oxford, England), 2021.PMID 33320197
[7]Hou Z, Yang T, Xu D, Fu J, Tang H, Zhao J, Zhang Q, Chen J, Qin Q, Li W, Chen H, Li H, Guo L, Xu B, Li Y hUC-MSCs loaded collagen scaffold for refractory thin endometrium caused by Asherman syndrome: a double-blind randomized controlled trial Stem cells translational medicine, 2025.PMID 40371958