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Prevalence of intrauterine adhesions after termination of pregnancy: a systematic review.
Eur J Contracept Reprod Health Care. 2016 Aug; 21(4):329-35.EJ

Abstract

OBJECTIVES

Termination of pregnancy (TOP) is one of the most performed interventions in women worldwide: approximately one in three women will have at least one TOP in their reproductive life. Intrauterine adhesions (IUAs) have been reported as a possible complication after TOP, but their prevalence has not been established, as women are not routinely evaluated. IUAs are associated with menstrual disturbances, infertility and obstetric complications.

METHODS

We searched Ovid MEDLINE, Ovid EMBASE and CENTRAL from inception until November 2015 for studies evaluating women following TOP. We selected studies in which women were evaluated consecutively, independently of symptoms, by hysteroscopy or hysterosalpingography (HSG), for the presence of IUAs.

RESULTS

After an extensive review of the literature, no studies were found that evaluated women after medical TOP and no randomised trials following surgical TOP. Only two prospective cohort studies were identified. In the first, IUAs were detected in 21.2% of women evaluated by hysteroscopy following first trimester surgical TOP; adhesions were moderate to severe in 48%. In the second, IUAs were detected in 16.2% of women evaluated by HSG after second trimester TOP by intra-amniotic prostaglandin induction followed by D&C; a pathologically wide internal cervical os was observed in 12%.

CONCLUSIONS

This systematic review suggests a link between TOP and adhesion formation, but, according to the scientific literature and despite new diagnostic facilities, the relationship between the methods of TOP and IUA formation remains unclear. Nevertheless, the reported frequency is in accordance with that found in women following D&C for miscarriage. Further research is required.

Authors+Show Affiliations

a Department of Obstetrics and Gynaecology , Zaans Medical Centre , Zaandam , The Netherlands ; b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;a Department of Obstetrics and Gynaecology , Zaans Medical Centre , Zaandam , The Netherlands ; c Department of Obstetrics , Haaglanden Medical Centre , The Hague , The Netherlands.b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27436757

Citation

Hooker, Angelo, et al. "Prevalence of Intrauterine Adhesions After Termination of Pregnancy: a Systematic Review." The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception, vol. 21, no. 4, 2016, pp. 329-35.
Hooker A, Fraenk D, Brölmann H, et al. Prevalence of intrauterine adhesions after termination of pregnancy: a systematic review. Eur J Contracept Reprod Health Care. 2016;21(4):329-35.
Hooker, A., Fraenk, D., Brölmann, H., & Huirne, J. (2016). Prevalence of intrauterine adhesions after termination of pregnancy: a systematic review. The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception, 21(4), 329-35. https://doi.org/10.1080/13625187.2016.1199795
Hooker A, et al. Prevalence of Intrauterine Adhesions After Termination of Pregnancy: a Systematic Review. Eur J Contracept Reprod Health Care. 2016;21(4):329-35. PubMed PMID: 27436757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of intrauterine adhesions after termination of pregnancy: a systematic review. AU - Hooker,Angelo, AU - Fraenk,Donachienne, AU - Brölmann,Hans, AU - Huirne,Judith, PY - 2016/7/21/entrez PY - 2016/7/21/pubmed PY - 2017/5/10/medline KW - Adhesion KW - Asherman’s syndrome KW - dilatation and curettage KW - induced abortion KW - misoprostol KW - pregnancy termination KW - systematic review SP - 329 EP - 35 JF - The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception JO - Eur J Contracept Reprod Health Care VL - 21 IS - 4 N2 - OBJECTIVES: Termination of pregnancy (TOP) is one of the most performed interventions in women worldwide: approximately one in three women will have at least one TOP in their reproductive life. Intrauterine adhesions (IUAs) have been reported as a possible complication after TOP, but their prevalence has not been established, as women are not routinely evaluated. IUAs are associated with menstrual disturbances, infertility and obstetric complications. METHODS: We searched Ovid MEDLINE, Ovid EMBASE and CENTRAL from inception until November 2015 for studies evaluating women following TOP. We selected studies in which women were evaluated consecutively, independently of symptoms, by hysteroscopy or hysterosalpingography (HSG), for the presence of IUAs. RESULTS: After an extensive review of the literature, no studies were found that evaluated women after medical TOP and no randomised trials following surgical TOP. Only two prospective cohort studies were identified. In the first, IUAs were detected in 21.2% of women evaluated by hysteroscopy following first trimester surgical TOP; adhesions were moderate to severe in 48%. In the second, IUAs were detected in 16.2% of women evaluated by HSG after second trimester TOP by intra-amniotic prostaglandin induction followed by D&C; a pathologically wide internal cervical os was observed in 12%. CONCLUSIONS: This systematic review suggests a link between TOP and adhesion formation, but, according to the scientific literature and despite new diagnostic facilities, the relationship between the methods of TOP and IUA formation remains unclear. Nevertheless, the reported frequency is in accordance with that found in women following D&C for miscarriage. Further research is required. SN - 1473-0782 UR - https://www.unboundmedicine.com/medline/citation/27436757/Prevalence_of_intrauterine_adhesions_after_termination_of_pregnancy:_a_systematic_review_ L2 - https://www.tandfonline.com/doi/full/10.1080/13625187.2016.1199795 DB - PRIME DP - Unbound Medicine ER -