The visual examination techniques—hysteroscopy and hysterography (X rays), and ultrasound—may also reveal that you have uterine abhesions in the cavity, known medically as Asherman syndrome if they are multiple. It can be hard to describe the adhesion to patients who find it difficult to visualize such a problem. Basically, they are pieces of scar tissue, or bands, that crisscross the lining of the womb (endometrium) like a spider’s web from one side wall to another. They have long been identified as a cause of infertility. Indeed, they are found in 68 percent of women with infertility problems who have had two or more D&C. we now know they may play a role as regards miscarriages, too.
Asherman syndrome was reported as far back as the end of the nineteenth century. In extreme cases, the entire uterine cavity is obliterated and menstruation may cease. Fro other women, the scars mean there is insufficient endometrial surface for the fetus to grow healthily.
The scars have come either from intrauterine infection, from D&C procedures (such as is required following a missed abortion), or from late elective abortions (terminations). They occur in as many as 15 percent of women who have had a D&C after a pregnancy but rare in women having a D&C unassociated with a pregnancy condition.
Once diagnosed by a hysterogram, the scars can be excised by dilating the cervix under general anesthesia and then cutting through the adhesion. This is done with the use of the hysteroscope, which makes each adhesion visible before cutting. An IUD (intrauterine device) is then placed in the uterus, and the patient is put on a course of estrogen, which prevents the adhesions from reforming, for about three months. After that time, the IUD is removed and the patient is advised to try for a pregnancy as quickly as possible.
Fibroids ( fibromyomas) are benign tumors of the muscle and fibrous tissue of the uterine wall. They can be present at different locations in the wall of the uterus: either in the thick middle section of the wall, there they are called intramural; on the suface of the uterus, where they are called intramural; on the suface of the uterus, where they are called subserous, and in this position, they can be on long stalks and feel separate from the uterus; or they may be in the depth of the uterine wall and bulge into the uterine cavity, where they are called submucus.
About 40 percent of women, by the stage of forty, have fibroids. Remember that they are benign awellings and generally do not require any treatment whatsoever unless they have grown very large in a short space of time, or they cause severe bleeding or pressure in the pelvis. Their role in causing miscarriage has been exaggerated, and the they are, in fact, an unusual cause of a miscarriage. Even during a continuing pregnancy, they seldom give any problem, except for some pain if they degenerate. They may cause premature labor if the placenta happens to implant over a fibroid. In general, fibroids, and certainly the small ones, should not be removed surgically in an effort to prevent miscarriage. They are best left alone.
So, abnormalities of the uterus may be responsible for a wide variety of gynecologic disorders, from infertility, to miscarriage, to premature labor, or to hemorrhages following delivery. Or, they may cause none of the above.
How common are uterine abnormalities as a cause of miscarriage?
In the medical literature of the last ten years, research shows that uterine abnormalities account for up to 12 percent of recurrent miscarriages, particularly those that take place between 12 and 24 weeks. Some women with an incompetent cervix may also have an abnormal uterus. Yet surprisingly, considering the extent of some abnormalities, that figure is not high. To look at the figure another way, the majority of women with uterine abnormalities will not experience any reproductive problem.
So do not be upset if, on discovering an anomaly, y our doctor decides against aggressive such as corrective surgery. The best method may be not treat you expectantly and  deal with an incompetent cervix during your next pregnancy on its merits.