Managing uterine evacuation in a patient with Asherman syndrome who failed procedural and medication abortions: a case report.

This report describes the case of a 37-year-old woman (G5P1041) with Asherman syndrome who failed both medication and procedural abortions. Her medical history included recurrent pregnancy loss, postpartum hemorrhage, and multiple suction and sharp dilation and curettages. She was found to have intrauterine adhesions and while awaiting lysis of adhesions, she became pregnant and desired termination of pregnancy. The patient's clinical course was as follows: unsuccessful vacuum aspiration at 6 weeks 0 days due to inability to reach the gestational sac, failed medication abortion, unsuccessful hysteroscopic abortion with morcellation at 6 weeks 5 days, and successful hysteroscopic removal of retained products of conception one month later. Clinical guidance is lacking for patients with intrauterine adhesions that fail procedural and medication abortions. This single case suggests that management modalities to consider include comprehensive preoperative planning, ultrasound guidance, hysteroscopic removal of the products of conception, use of second-look hysteroscopy, and close postoperative follow-up.