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Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study.
BJOG. 2018 Oct; 125(11):1424-1431.BJOG

Abstract

OBJECTIVE

Intrauterine adhesions (IUAs) are a problematic complication after termination of pregnancy, but their incidence is unknown. Our objective was to assess the incidence of IUAs following induced termination of pregnancy and the risk factors for IUAs.

DESIGN

Retrospective cohort study.

SETTING

A nationwide registry study.

SAMPLE

All women undergoing induced termination of pregnancy (n = 80 015) in Finland between 2000 and 2008.

METHODS

The data were retrieved from the Finnish Abortion Registry and the Hospital Discharge Registry. The diagnosis of IUAs or complications was based on the diagnostic codes (International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) and operative codes according to the Nordic Medico-Statistical Committee (NOMESCO) Classification of Surgical Procedures (NCSP). IUAs were defined as ICD-10 code N85.6 or operative code LCG02. A subanalysis of IUA cases and five matched controls was performed.

MAIN OUTCOME MEASURES

The incidence of and risk factors for IUAs.

RESULTS

A total of 12 (1.5 per 10 000) IUA diagnoses were identified from 79 960 eligible induced terminations of pregnancy. The rate of IUAs was 1.5 and 2.0 cases per 10 000 terminations of pregnancy following medically and surgically induced termination of pregnancy, respectively (P = 0.19). In a subgroup analysis of IUA cases and five matched controls, surgical treatment of the remaining products of conception following termination of pregnancy significantly increased the risk of IUAs (odds ratio, OR 5.50; 95% confidence interval, 95% CI 1.46-20.79; P = 0.012).

CONCLUSION

IUAs that require further treatment are rare after an induced termination of pregnancy. Surgical evacuation following medical or surgical termination of pregnancy was a risk factor for the diagnosis of IUAs. These results suggest that trauma to a recently pregnant uterus is an important risk factor for IUAs.

TWEETABLE ABSTRACT

IUA is rare after induced termination of pregnancy (iTOP), but surgical evacuation is a risk factor for IUAs.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland.The National Institute for Health and Welfare, Helsinki, Finland. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden.Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29532588

Citation

Mentula, M, et al. "Intrauterine Adhesions Following an Induced Termination of Pregnancy: a Nationwide Cohort Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 125, no. 11, 2018, pp. 1424-1431.
Mentula M, Männistö J, Gissler M, et al. Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study. BJOG. 2018;125(11):1424-1431.
Mentula, M., Männistö, J., Gissler, M., Heikinheimo, O., & Niinimäki, M. (2018). Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study. BJOG : an International Journal of Obstetrics and Gynaecology, 125(11), 1424-1431. https://doi.org/10.1111/1471-0528.15216
Mentula M, et al. Intrauterine Adhesions Following an Induced Termination of Pregnancy: a Nationwide Cohort Study. BJOG. 2018;125(11):1424-1431. PubMed PMID: 29532588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study. AU - Mentula,M, AU - Männistö,J, AU - Gissler,M, AU - Heikinheimo,O, AU - Niinimäki,M, Y1 - 2018/04/26/ PY - 2018/01/05/accepted PY - 2018/3/14/pubmed PY - 2019/3/8/medline PY - 2018/3/14/entrez KW - Incidence KW - induced termination of pregnancy KW - intrauterine adhesions SP - 1424 EP - 1431 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 125 IS - 11 N2 - OBJECTIVE: Intrauterine adhesions (IUAs) are a problematic complication after termination of pregnancy, but their incidence is unknown. Our objective was to assess the incidence of IUAs following induced termination of pregnancy and the risk factors for IUAs. DESIGN: Retrospective cohort study. SETTING: A nationwide registry study. SAMPLE: All women undergoing induced termination of pregnancy (n = 80 015) in Finland between 2000 and 2008. METHODS: The data were retrieved from the Finnish Abortion Registry and the Hospital Discharge Registry. The diagnosis of IUAs or complications was based on the diagnostic codes (International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) and operative codes according to the Nordic Medico-Statistical Committee (NOMESCO) Classification of Surgical Procedures (NCSP). IUAs were defined as ICD-10 code N85.6 or operative code LCG02. A subanalysis of IUA cases and five matched controls was performed. MAIN OUTCOME MEASURES: The incidence of and risk factors for IUAs. RESULTS: A total of 12 (1.5 per 10 000) IUA diagnoses were identified from 79 960 eligible induced terminations of pregnancy. The rate of IUAs was 1.5 and 2.0 cases per 10 000 terminations of pregnancy following medically and surgically induced termination of pregnancy, respectively (P = 0.19). In a subgroup analysis of IUA cases and five matched controls, surgical treatment of the remaining products of conception following termination of pregnancy significantly increased the risk of IUAs (odds ratio, OR 5.50; 95% confidence interval, 95% CI 1.46-20.79; P = 0.012). CONCLUSION: IUAs that require further treatment are rare after an induced termination of pregnancy. Surgical evacuation following medical or surgical termination of pregnancy was a risk factor for the diagnosis of IUAs. These results suggest that trauma to a recently pregnant uterus is an important risk factor for IUAs. TWEETABLE ABSTRACT: IUA is rare after induced termination of pregnancy (iTOP), but surgical evacuation is a risk factor for IUAs. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/29532588/Intrauterine_adhesions_following_an_induced_termination_of_pregnancy:_a_nationwide_cohort_study_ L2 - https://doi.org/10.1111/1471-0528.15216 DB - PRIME DP - Unbound Medicine ER -