INTRAUTERINE ADHESIONS AFTER MANUAL/ELECTRIC VACUUM ASPIRATION WITHOUT SHARP CURETTAGE

Manual vacuum aspiration (MVA) and electric vacuum aspiration (EVA) are options for surgical management of early pregnancy loss and undesired pregnancy, as well as diagnostic work-up for pregnancy of unknown location. Though rare, these procedures can be associated with the risk of intrauterine adhesions (IUAs). This is referred to as Asherman’s syndrome when associated with symptoms such as infertility, menstrual abnormalities, or recurrent pregnancy loss.1 The true incidence of IUAs after MVA/EVA is not well established but is estimated to range from 2%-30%.2-4 However, most available literature either includes the use of sharp curettage or does not specify whether sharp curettage was used.2-4 To describe the occurrence of intrauterine adhesions after manual/electric vacuum aspiration without sharp curettage for management of early pregnancy loss, undesired pregnancy, and diagnostic evaluation for pregnancy of unknown location. ICD-9 and ICD-10 codes for intrauterine synechiae were queried from 2016-2021. Charts were reviewed to identify patients who had both undergone a first trimester MVA/EVA for early pregnancy loss, undesired pregnancy or pregnancy of unknown location, followed by hysteroscopy confirming intrauterine adhesions. The following variables were also collected: indication for procedure, gestational age, type of cannula, use of sharp curettage, indication for hysteroscopy, and description of adhesions. Patients with the diagnosis of retained products of conception were excluded, as well as patients who had undergone more than two aspiration procedures. Between January 1, 2016 and Jun 30, 2021, 1060 first trimester aspiration procedures were performed at our institution. No sharp curettage was used in any of these cases. Five patients (0.5%) with intrauterine adhesions were identified, all of whom re-presented for infertility evaluation. Two had undergone two aspiration procedures for separate pregnancy episodes before their hysteroscopies were performed. Intrauterine adhesions are a possible complication of aspiration procedures, even in the absence of sharp curettage. Although rare, this complication does occur and should be included in the counseling process. Treatment options and their associated risks should be offered in the context of patients’ preferences and reproductive goals.