myths

1.  MYTH: Suction, or manual vacuum aspiration evacuations (D&Es) do not cause Asherman’s Syndrome.

FACT: There is no data to indicate D&Es are less likely to lead to intrauterine scarring than sharp curettage. Not only has the rate of Asherman’s Syndrome not gone down since suction D&E was introduced, but a recent article describes three cases of women who developed scarring following manual vacuum aspiration.  Note that sharp curettage and suction are often both used in the same procedure.

2.  MYTH: Asherman’s Syndrome, aka intrauterine scarring/adhesions or synechiae, is very rare.

FACT: In summary of publications in peer-reviewed medical journals, the risk of intrauterine adhesions after D&C for a missed miscarriage is as high as 30.9%. After a repeat procedure, the incidence is as high as 40%. (1)

3.  MYTH: All OB/GYNs warn patients about the risk of Asherman’s Syndrome and are informed enough to diagnose it.

FACT: Most doctors do not mention scarring as a risk factor — few Asherman’s sufferers received any warning prior to their D&C. Dr. Charles March of California Fertility Partners, in his article “Management of Asherman’s Syndrome” says:

“Most physicians believe that AS occurs rarely and do not suspect the diagnosis even in the presence of clear symptoms. Table 1 details its prevalence among those with various conditions or after various uterine surgeries. It demonstrates convincingly that AS is anything but rare.”

(See the table here; please note that “spontaneous abortion” is synonymous with miscarriage.)

4.  MYTH: D&Cs are completely safe, routine procedures.

FACT: Beyond Asherman’s Syndrome, there are multiple serious risks factors for a D&C, among them:

5.  MYTH: A D&C is more effective than Misoprostol (Cytotec) pill or natural miscarriage.

FACT: Medical research has shown that medical management (Misoprostol pill) or expectant management (natural miscarriage) are as effective as curettage in assuring complete evacuation.(2) One randomized control study suggests that Misoprostol would reduce the incidence of intrauterine adhesions.(3)

References

  1. Adoni, A, Palti, Z, Milwidsky, A, and Dolberg, M. The incidence of intrauterine adhesions following spontaneous abortion. Int J Fertil 1982;27(2):117-8.
  2. Blohm F, Hahlin M, Nielsen S, Milsim I. Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment. Lancet. 1997;349:995; Smith LFP, Ewings PD, Quinlan C. Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial. Br. Med. J. 2009;339:3827
  3. Tam, WH, Lau, WC, Cheung, LP, Yuen, PM, and Chung, TK. Intrauterine
    adhesions after conservative and surgical management of spontaneous abortion. JAm Assoc Gynecol Laparosc 2002;9(2):182-5.
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