Haemorrhage in pregnancy that occurs due to presence of any scars or scar tissue in the uterus, which damages the endometrium (the lining of the uterus), is called:

1. A

   incompetent cervix

2. B

   Asherman's syndrome

3. C

   bicornuate uterus

4. D

   septate uterus

Appeared in: NHM UP Staff Nurse-2023 Shift-2nd

Explanation

• Asherman's syndrome is the medical term for the formation of intrauterine adhesions or scar tissue.
• This condition is acquired, typically after uterine surgery like a dilatation and curettage (D&C), which can damage the basal layer of the endometrium.
• The resulting scar tissue can prevent proper placental implantation and growth, leading to complications such as recurrent pregnancy loss and hemorrhage.

Why Other Options Were Wrong

• Option A: Incompetent cervix, or cervical insufficiency, relates to the premature and painless opening of the cervix during pregnancy. It does not involve endometrial scarring.
• Option C: A bicornuate uterus is a congenital malformation where the uterus is heart-shaped. It is a structural defect present from birth, not acquired scarring.
• Option D: A septate uterus is another congenital anomaly where a wall of tissue (septum) divides the uterine cavity. It is not caused by acquired scar tissue.

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Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Uterine abnormalities affecting pregnancy as background academic context rather than a clinical decision trigger.
• A thorough patient history is crucial. Nurses should ask about previous uterine surgeries (D&C, myomectomy), postpartum hemorrhage, or endometritis, as these are significant risk factors for developing Asherman's syndrome.
• Management often involves hysteroscopic adhesiolysis, a surgical procedure to cut and remove the scar tissue, which can restore fertility and reduce the risk of pregnancy complications.
• What if? If a patient presented with amenorrhea (absence of periods) and infertility after a recent D&C, Asherman's syndrome would be a primary suspicion, prompting investigation with hysteroscopy or saline infusion sonography.

How to Approach the Question

• First, identify the key phrases in the question: "scars or scar tissue in the uterus" and "damages the endometrium."
• This points towards an acquired condition that affects the uterine lining, rather than a structural defect present from birth.
• Evaluate the options: 'Bicornuate uterus' and 'septate uterus' are congenital (developmental) anomalies, so they can be eliminated.
• 'Incompetent cervix' refers to a problem with the cervix holding the pregnancy, not scarring within the uterine cavity.
• This leaves 'Asherman's syndrome,' which is the specific medical term for acquired intrauterine adhesions (scar tissue).

Concept Tested & Keywords

• Concept Tested: Uterine abnormalities affecting pregnancy
• Stem keywords: Haemorrhage in pregnancy, scars, scar tissue, uterus, endometrium
• Lead-in keywords: is called

Question ID

Q9OgZgmeuc0EnacyW_osoe

Copy ID

Reference Book

E6 Gynecology Williams pp. 396-403, 156-188