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Comparison of intrauterine adhesion classification systems

Comparison of intrauterine adhesion classification systems
Source Summary of classification
March et al[1] Adhesions classified as minimal, moderate, or severe based on hysteroscopic assessment of the degree of uterine cavity involvement.
Hamou et al[2] Adhesions classified as isthmic, marginal, central, or severe according to hysteroscopic assessment.
Valle and Sciarra[3] Adhesions classified as mild, moderate, or severe according to hysteroscopic assessment and extent of occlusion (partial or total) at HSG.
Wamsteker; European Society for Hysteroscopy[4] Complex system classifies IUAs as Grades I through IV with several subtypes and incorporates a combination of hysteroscopic and HSG findings and clinical symptoms.
American Fertility Society[5] Complex scored system of mild, moderate, or severe IUAs based on extent of endometrial cavity obliteration, appearance of adhesions, and patient menstrual characteristics based on hysteroscopic or HSG assessment.
Donnez and Nisolle[6] Adhesions classified into six grades on the basis of location, with postoperative pregnancy rate the primary driver. Hysteroscopy or HSG is used for assessment.
Nasr et al[7] Complex system creates a prognostic score by incorporating menstrual and obstetric history with IUA findings at hysteroscopic assessment.
HSG: hysterosalpingograpy; IUA: intrauterine adhesion.
References:
  1. March C, Israel R, March A. Hysteroscopic managment of intrauterine adhesions. Am J Obstet Gynecol 1978; 130:653.
  2. Hamou J, Salat-Baroux J, Siegler A. Diagnosis and treatment of intrauterine adhesions by microhysteroscopy. Fertil Steril 1983; 39:321.
  3. Valle RF, Sciarra JJ. Intrauterine adhesions: Hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol 1988; 158:1459.
  4. Wamsteker K. European Society for Hysteroscopy (ESH) classification of IUA. 1989.
  5. American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49:944.
  6. Donnez J, Nisolle M. Hysteroscopic adheisolysis of intrauterine adhesions (Asherman syndrome), Donnez J (Ed), Parthenon Publishing Group, London 1994.
  7. Nasr A, Al-Inany H, Thabet S, Aboulghar M. A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Invest 2000; 50:178.
Reproduced from: AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol 2010; 17:1. Table used with the permission of Elsevier, Inc. All rights reserved.
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