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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.
Chinese abstract
目的：终止妊娠（TOP）是全世界妇女最常见的干预措施之一：大约三分之一的女性在育龄期中至少发生一次。宫腔粘连(IUAs)被报道是在TOP后可能发生的并发症, 但因为没有常规评估, 患病率未确定。IUAs与月经失调、不孕、产科并发症相关。方法：我们搜索了Ovid MEDLINE, Ovid EMBASE 和 CENTRAL中从建立到2015年11月TOP后评估妇女的研究。我们选择那些通过宫腔镜或子宫输卵管造影术（HSG）连续评估, 有独立症状, 存在IUAs的妇女的研究。结果：广泛回顾文献后, 未发现评估妇女药物TOP后的研究和手术TOP后的随机试验。只有两个前瞻队列研究被确认。第一个研究, 通过宫腔镜评估早期妊娠的妇女手术TOP后 IUAs 21.2%, 中度及严重粘连得发生率为48%。第二个研究, 通过子宫输卵管造影术评估中期妊娠之后行羊膜腔前列腺素诱导TOP后行D&C手术者, IUAs 为16.2%。宫颈管病理性扩大者占12%。结论：这个系统综述提示了TOP和粘连形成之间的联系, 虽然根据科学文献, 有新的诊断技术, 但是TOP的方法和IUA形成之间的关系仍不清楚。虽然如此, 报道的频率是来源于那些流产后D&C的妇女, 需要进一步的研究。
Acknowledgements
The authors would like to thank Linda Kos for her contribution in developing the search strategy and running searches on a periodic basis.
Disclosure statement
No conflicts of interest are declared. No internal or external funding was either sought or obtained for this study.