title: Curettage and Asherman's syndrome-lessons to (re-) learn?
abstract: OBJECTIVE
  To investigate the noted cluster of cases of Asherman's syndrome in an 18-month period at an Early Pregnancy Assessment Centre at a tertiary care institution.
  
  
  METHODS
  A practice audit was performed involving (a) a detailed chart review of the six index cases; and (b) compilation of treatment choices for all new patient referrals in the same 18-month time frame from July 2011 to December 2012. Diagnosis of Asherman's syndrome was made with a combination of clinical menstrual symptoms and hysteroscopic diagnosis of intrauterine adhesions.
  
  
  RESULTS
  Of 1580 new patient referrals, 884 chose one of four forms of active management for early pregnancy failure. Six women (6/844, 0.7%) were subsequently found to have Asherman's syndrome. All six women (100%) underwent sharp curettage, and three (50%) had repeat curettage performed. No cases of Asherman's were reported following manual vacuum aspiration (0/191) or medical management with misoprostol (0/210).
  
  
  CONCLUSIONS
  Asherman's syndrome remains a risk for those undergoing dilatation and curettage for management of spontaneous abortion and should be an important component of the informed consent for this procedure. Both sharp and repeated curettage remain important risk factors and should be employed judiciously. The evaluation of the common risk factors associated with these cases could target changes in practice.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Gilman Barber
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Early Pregnancy Assessment Clinic, BC Women's Hospital and Health Centre, Vancouver BC.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Rhone
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Early Pregnancy Assessment Clinic, BC Women's Hospital and Health Centre, Vancouver BC.
authors.forename: Margo R
authors.initials: MR
authors.lastname: Fluker
mesh_terms: D000022:Abortion, Spontaneous; D000328:Adult; D054869:Clinical Audit; D004107:Dilatation and Curettage / Q000009:adverse effects*; D005260:Female; D006175:Gynatresia / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D012086:Reoperation
keywords: Asherman’s syndrome; dilatation and curettage; intrauterine adhesions; spontaneous abortion