Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

Mentula, Maarit; Männistö, Jaana; Gissler, Mika; Heikinheimo, Oskari; Niinimäki, Maarit

doi:10.1111/1471-0528.15216

Cited by 17 publications

(13 citation statements)

References 24 publications

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“…A nationwide study from Finland evaluated 79 960 women who had induced termination of pregnancy and depending on the diagnostic codes of medical records, they reported a rate of 1.5 and 2.0 cases per 10 000 medically and surgically induced terminations of pregnancies, respectively 13 . A study evaluating the risk factors of Asherman Syndrome among 61 patients reported induced abortions and miscarriages were the main risk factor for IUA 14 …”

Section: Discussionmentioning

confidence: 99%

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

Sevinç

Oskovi-Kaplan

Çelen

et al. 2021

J of Obstet and Gynaecol

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Aim To evaluate the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine evacuation and curettage. Methods A total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo‐amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints. Results The incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome. Conclusion When the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.

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Section: Discussionmentioning

confidence: 99%

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

Sevinç

Oskovi-Kaplan

Çelen

et al. 2021

J of Obstet and Gynaecol

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“…Intrauterine adhesion (IUA), also referred to as Asherman syndrome, is a complication of partial or full adhesion in the uterine cavity due to fibrous tissue proliferation after uterine wall and endometrial injury during pregnancy (1,2). IUA can not only cause menstrual disorders including oligomenorrhea, amenorrhea and periodic lower abdominal pain, but also fertility disorders such as infertility, abortion, and placental abnormalities (3).…”

Section: Introductionmentioning

confidence: 99%

Establishment of an animal model of intrauterine adhesions after surgical abortion and curettage in pregnant rats

et al. 2020

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Background: Intrauterine adhesion (IUA), also referred to as Asherman syndrome, is a complication with partial or complete adhesion of the uterine cavity due to fibrotic proliferation after endometrial and uterine wall injury of the newly pregnant uterus. Currently, all IUA research models are based on non-pregnant animals which are ill-suited in mimicking its pathogenesis. This study aimed to establish an animal IUA model caused by surgical abortion and curettage in pregnant rats that is more in line with clinical etiology, and to provide a more ideal animal model for further exploration of the pathogenesis and treatment for IUA.Methods: Fifteen, 13-to-15-day pregnant Sprague-Dawley (SD) rats aged 10 weeks were selected. After incising and removing the embryos, we randomly selected one side of the uterine cavity as the study group (n=15) and scraped it with a curette; the contralateral side of the uterine cavity that underwent no special procedures was used for inclusion in the control group (n=15). Five rats were euthanized and dissected on the 3rd, 7th, and 14th day after surgery respectively. The changes in tissue morphology, the number of endometrial glands, the ratio of endometrial fibrotic area, and the expression level of the transforming growth factor beta (TGF-β) in the endometrium were compared between the 2 groups.Results: The endometrial granular cell number in the study group on the 7th and 14th day postoperatively was 3.87±0.72 & 2.59±0.90 in each visual field (×100) respectively, which was significantly lower than that of the control group (6.48±0.96 & 7.53±1.10; P<0.05). The ratio of the endometrial stromal fibrotic area in the study group was significantly higher than that of the control group post-operatively on the 3rd day (0.0974±0.0430 vs. 0.0584±0.05110), 7th day (0.1551±0.0348 vs. 0.0328±0.0152), and 14th day (0.1518±0.0477 vs. 0.0311±0.0128) (P<0.05). The endometrial TGF-β expression in the study group was positive on the 14th day postoperatively while weakly expressed in the control group, and the integrated optical density (IOD) value (5,608.8±2,887.3) was higher than that of the control group (388.3±98.6) (P<0.05).The endometrial TGF-β expression in the study group and control group was relatively weak on the 3rd and 7th day after surgery, and there was no significant difference when compared with that of the control group (P>0.05). Conclusions:The establishment of an animal model of IUA after surgical abortion and curettage in pregnant rats was successful and is thus feasible for further studies; the model may be a more effective mimic for the generation of human IUA.

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“…Intrauterine adhesion (IUA) is characterized by reduced menstrual blood volume, amenorrhea, infertility, and recurrent abortion (1), which seriously affects the reproductive health of women. Hysteroscopy is the preferred diagnostic method for IUAs; transcervical resection of adhesion (TCRA) is the standard surgical procedure to treat IUAs and plays an irreplaceable role in separating IUAs (2).…”

Section: ' Introductionmentioning

confidence: 99%

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

Pan

Wang

Chen

2021

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Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

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

Cited by 17 publications

References 24 publications

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

Identifying the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine curettage

Establishment of an animal model of intrauterine adhesions after surgical abortion and curettage in pregnant rats

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

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