title: Prevalence of intrauterine adhesions after termination of pregnancy: a systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: a Department of Obstetrics and Gynaecology , Zaans Medical Centre , Zaandam , The Netherlands ;|b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;
authors.forename: Angelo
authors.initials: A
authors.lastname: Hooker
authors.affiliation: a Department of Obstetrics and Gynaecology , Zaans Medical Centre , Zaandam , The Netherlands ;|c Department of Obstetrics , Haaglanden Medical Centre , The Hague , The Netherlands.
authors.forename: Donachienne
authors.initials: D
authors.lastname: Fraenk
authors.affiliation: b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;
authors.forename: Hans
authors.initials: H
authors.lastname: Brölmann
authors.affiliation: b Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands ;
authors.forename: Judith
authors.initials: J
authors.lastname: Huirne
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000022:Abortion, Spontaneous; D004107:Dilatation and Curettage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy; D015995:Prevalence; D000267:Tissue Adhesions; D014591:Uterine Diseases / Q000453:epidemiology*
keywords: Adhesion; Asherman’s syndrome; dilatation and curettage; induced abortion; misoprostol; pregnancy termination; systematic review