Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

Objective Intrauterine adhesions ( IUA s) are a problematic complication after termination of pregnancy, but their incidence is unknown. Our objective was to assess the incidence of IUA s following induced termination of pregnancy and the risk factors for IUA s. Design Retrospective cohort study. Setting A nationwide registry study. Sample All women undergoing induced termination of pregnancy ( n = 80 015) in Finland between 2000 and 2008. Methods The data were retrieved from the Finnish Abortion Registry and the Hospital Discharge Registry. The diagnosis of IUA s or complications was based on the diagnostic codes (International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD ‐10) and operative codes according to the Nordic Medico‐Statistical Committee ( NOMESCO ) Classification of Surgical Procedures ( NCSP ). IUA s were defined as ICD ‐10 code N85.6 or operative code LCG 02. A subanalysis of IUA cases and five matched controls was performed. Main outcome measures The incidence of and risk factors for IUA s. Results A total of 12 (1.5 per 10 000) IUA diagnoses were identified from 79 960 eligible induced terminations of pregnancy. The rate of IUA s was 1.5 and 2.0 cases per 10 000 terminations of pregnancy following medically and surgically induced termination of pregnancy, respectively ( P = 0.19). In a subgroup analysis of IUA cases and five matched controls, surgical treatment of the remaining products of conception following termination of pregnancy significantly increased the risk of IUA s (odds ratio, OR 5.50; 95% confidence interval, 95% CI 1.46–20.79; P = 0.012). Conclusion IUA s that require further treatment are rare after an induced termination of pregnancy. Surgical evacuation following medical or surgical termination of pregnancy was a risk factor for the diagnosis of IUA s. These results suggest that trauma to a recently pregnant uterus is an important risk factor for IUA s. Tweetable abstract IUA is rare after induced termination of pregnancy ( iTOP ), but surgical evacuation is a risk factor for IUA s.