title: Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors?
abstract: OBJECTIVE
  To assess the prevalence and risk factors for intrauterine adhesions (IUAs) after hysteroscopic treatment of retained products of conception (RPOC).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Gynecologic endoscopy unit.
  
  
  METHODS
  A total of 167 women referred to our institution from 2009 to 2013.
  
  
  METHODS
  Operative hysteroscopy for treatment of RPOC and office hysteroscopic follow-up to assess for IUA.
  
  
  METHODS
  We investigated demographic characteristics, obstetrics parameters, and surgical variables to evaluate which factors could be associated with IUA formation.
  
  
  RESULTS
  Of 167 women treated for RPOC, 84 (50.3%) had undergone a follow-up hysteroscopic evaluation after the operative hysteroscopy and were included in the study. Intrauterine adhesions were found in 16 cases (19.0%), of which only 3 (3.6%) were severe adhesions. Multivariate analysis showed that the presence of IUA was associated with RPOC after cesarean section (5 of 10 [50.5%] developed IUA, vs. 7 of 49 [14.3%] after vaginal delivery). Intrauterine adhesions were also found in 4 of 23 women (17.4%) undergoing hysteroscopy for RPOC after abortion. Patient age, gravidity, parity, and the interval between the index pregnancy and treatment for RPOC were not associated with postoperative IUA.
  
  
  CONCLUSIONS
  Hysteroscopic treatment for RPOC had a 3.6% incidence of severe intrauterine adhesions formation in this descriptive series. Women with RPOC occurring after delivery by cesarean section are particularly at risk for development of IUA.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Oshri
authors.initials: O
authors.lastname: Barel
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Krakov
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel. Electronic address: mpansky@gmail.com.
authors.forename: Moty
authors.initials: M
authors.lastname: Pansky
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vaknin
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Reuvit
authors.initials: R
authors.lastname: Halperin
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Smorgick
mesh_terms: D000027:Abortion, Incomplete / Q000453:epidemiology / Q000601:surgery*; D000028:Abortion, Induced / Q000009:adverse effects* / Q000706:statistics & numerical data; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions; D014591:Uterine Diseases / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
keywords: Adhesions; Asherman; conception; hysteroscopy; products; retained