Grades of Ashermans Syndrome Severity

Society for Hysteroscopy, 1989:

I - Thin or filmy adhesions easily ruptured by hysteroscope sheath alone, cornual areas normal;

II - Singular firm adhesions connecting separate parts of the uterine cavity, visualization of both tubal ostia possible, cannot be ruptured by hysteroscope sheath alone;

IIa - Occluding adhesions only in the region of the internal cervical OS. Upper uterine cavity normal;

III - Multiple firm adhesions connecting separate parts of the uterine cavity, unilateral obliteration of ostial areas of the tubes;

IIIa - Extensive scarring of the uterine cavity wall with amenorrhea or hypomenorrhea;

IIIb - Combination of III and IIIa;

IV - Extensive firm adhesions with agglutination of the uterine walls. Both tubal ostial areas occluded

Valle and Sciarra's 1988 classification

Mild- Filmy adhesions composed of basal endometrium producing partial or complete uterine cavity occlusion;

Moderate - Fibromuscular adhesions that are characteristically thick, still covered by endometrium that may bleed on division, partially or totally occluding the uterine cavity;

Severe - Composed of connective tissue with no endometrial lining and likely to bleed upon division, partially or totally occluding the uterine cavity.

Donnez and Nisolle 1994 classification

I - Central adhesions

a) thin filmy adhesions (endometrial adhesions)

b) myofibrous (connective adhesions)

II - Marginal adhesions (always myofibrous or connective)

a) wedge like projection

b) obliteration of one horn

III - Uterine cavity absent on HSG

a) occlusion of the internal os (upper cavity normal)

b) extensive agglutination of uterine walls (absence of uterine cavity - true  Asherman's)

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