A woman who underwent dilatation and curettage for a first-trimester miscarriage presents a year later with secondary amenorrhoea and cyclic lower abdominal pain. Hysteroscopy shows bands of fibrous tissue obliterating the uterine cavity. What is the most likely diagnosis?

• A Endometrial tuberculosis
• B Sheehan syndrome
• C Cervical stenosis with haematometra
• D Asherman syndrome ✓

Explanation

Intrauterine adhesions after aggressive post-abortal curettage produce Asherman syndrome, characterised by amenorrhoea or hypomenorrhoea, cyclical pain from trapped menstruation, and infertility. Hysteroscopy showing adhesion bands confirms it. Sheehan syndrome follows postpartum pituitary necrosis and gives panhypopituitarism with absent lactation, not cyclical pain. Pure cervical stenosis spares the cavity. Endometrial tuberculosis can cause adhesions but the history of recent curettage makes iatrogenic injury the clear cause here.

Reference: DC Dutta's Textbook of Gynecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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