Hooker Angelo, Fraenk Donachienne, Brölmann Hans, Huirne Judith
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 ;
Eur J Contracept Reprod Health Care. 2016 Aug;21(4):329-35. doi: 10.1080/13625187.2016.1199795.
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.
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.
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%.
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.
终止妊娠（TOP）是全球女性中实施最为频繁的干预措施之一：约三分之一的女性在其生育期内至少会经历一次TOP。据报道，子宫内粘连（IUA）是TOP后的一种可能并发症，但其发生率尚未确定，因为女性未接受常规评估。IUA与月经紊乱、不孕及产科并发症相关。
我们检索了从数据库建库至2015年11月的Ovid MEDLINE、Ovid EMBASE和CENTRAL数据库，以查找评估TOP后女性的研究。我们选择了通过宫腔镜检查或子宫输卵管造影（HSG）对女性进行连续评估（不论有无症状）以确定是否存在IUA的研究。
在对文献进行广泛综述后，未发现评估药物流产后女性的研究，也未发现手术流产后的随机试验。仅确定了两项前瞻性队列研究。第一项研究中，孕早期手术流产后接受宫腔镜检查的女性中有21.2%检测到IUA；48%的粘连为中度至重度。第二项研究中，经羊膜腔内前列腺素引产继以刮宫术进行中期妊娠流产后接受HSG检查的女性中有16.2%检测到IUA；12%观察到宫颈内口病理性增宽。
本系统综述提示TOP与粘连形成之间存在关联，但根据科学文献，尽管有新的诊断设备，TOP方法与IUA形成之间的关系仍不明确。然而，报告的发生率与流产刮宫术后女性中的发生率一致。仍需进一步研究。
