Post-Abortion Complications: Adhesions and Fertility Concerns

Q: Post-Abortion Complications: Adhesions and Fertility Concerns

Desire to be a mother： Hello! According to your statement, in medical terms, what is commonly referred to as abortion is known as induced abortion. <br>This procedure may be performed due to maternal health issues or fetal abnormalities, and some may request termination of pregna

Sequelae

Hello, Doctor.
I underwent a dilation and curettage (D&C) procedure for abortion last year.
During that time, the small ball and fluid were continuously impacting the fetus in my uterus, leading to the miscarriage.
I would like to know if such external forces could cause adhesions in the uterus.
I have not used contraception for two months and have been engaging in intercourse during my fertile window, but I have not become pregnant yet.
I am worried that the previous abortion may have left me with complications that could lead to infertility in the future.
Are there any tests available to check for adhesions or abnormalities inside the uterus? Can these issues be treated? Please, I really need your answers! Thank you!

Ke ai dang mama de ren, 20~29 year old female. Ask Date: 2002/12/04

Dr. Chen Fuhao reply Obstetrics and Gynecology

Desire to be a mother: Hello! According to your statement, in medical terms, what is commonly referred to as abortion is known as induced abortion.
This procedure may be performed due to maternal health issues or fetal abnormalities, and some may request termination of pregnancy if they have had enough children or are currently not ready for a child.
The choice of method for induced abortion varies based on gestational age and fetal size; before twelve weeks, the most commonly used method is suction curettage (also known as menstrual regulation).
Other methods include dilation and curettage (D&C), vacuum aspiration, and the recently popular RU486 abortion pill.
After twelve weeks, options include hypertonic saline injection, prostaglandin-induced abortion, extra-amniotic induction, and the most common method, oxytocin.
Sometimes, if the fetus cannot be expelled from the uterus, more invasive procedures such as hysterotomy may be necessary.
Therefore, there are many methods for induced abortion, and it should not pose significant difficulties in today's medical practice.
However, there are considerable risks associated with induced abortion, and improper procedures can lead to varying degrees of complications.
For example, the generally considered simplest and safest method, suction curettage, can have common complications such as cervical injury, bleeding, infection, severe cramping, and incomplete evacuation, especially with advanced gestational age, which increases the risk.
There have even been cases of uterine perforation, bleeding, injury, infection, shock, and death due to improper abortion procedures.
Improper induced abortion may also lead to infertility, which underscores the importance of effective family planning.
If pregnancy occurs and abortion becomes necessary, it is crucial to seek a qualified obstetrician-gynecologist as soon as possible.
Regarding your concerns about adhesions, not conceiving after two months of unprotected intercourse during the fertile period, I suggest you remain calm, first measure your basal body temperature, and then consult a qualified obstetrician-gynecologist for an examination.
It is essential to maintain a relaxed mindset and not put too much pressure on yourself, paying attention to the balance of physical and mental well-being.
Perhaps soon you will receive good news.
Best wishes!

Reply Date: 2002/12/04

More Info

Understanding post-abortion complications, particularly concerning adhesions and fertility, is crucial for women who have undergone such procedures. After an abortion, whether it is a medical or surgical one, there can be concerns about future fertility and the potential for complications such as intrauterine adhesions, commonly known as Asherman's syndrome. This condition occurs when scar tissue forms inside the uterus, which can lead to menstrual irregularities and difficulties in conceiving.

In your case, it is understandable to be concerned about the possibility of adhesions forming after your abortion, especially given the circumstances you described. The mechanical forces involved in the procedure, particularly if there was significant manipulation of the uterus, can indeed lead to the formation of scar tissue. However, it is important to note that not all women who undergo an abortion will experience these complications. The risk factors for developing adhesions include the type of procedure performed, the presence of infection, and individual healing responses.

If you have been trying to conceive for two months without success, it is natural to feel anxious, but it is also important to recognize that two months is a relatively short time in the context of trying to conceive. Many couples may take several months or even longer to achieve pregnancy, and various factors can influence fertility, including timing, ovulation, and overall reproductive health.

To assess whether you have developed any adhesions or other abnormalities in your uterus, there are several diagnostic options available:
1. Hysterosalpingography (HSG): This is an X-ray procedure where a dye is injected into the uterus and fallopian tubes. It can help visualize the shape of the uterine cavity and check for blockages in the fallopian tubes.

2. Sonohysterography (SHG): This is an ultrasound procedure where saline is injected into the uterus to provide a clearer image of the uterine lining and detect any abnormalities, including polyps or fibroids.

3. Hysteroscopy: This is a more invasive procedure where a thin, lighted tube is inserted into the uterus through the cervix. It allows direct visualization of the uterine cavity and can also be used to remove any adhesions if they are found.

If adhesions are confirmed, treatment options are available. Hysteroscopic surgery can be performed to remove the scar tissue, which may improve your chances of conceiving. It is essential to consult with a fertility specialist or a gynecologist who can provide personalized advice based on your medical history and current situation.

In conclusion, while there is a possibility of developing adhesions after an abortion, not all women experience this complication. If you have concerns about your fertility, it is advisable to seek medical evaluation. Early diagnosis and intervention can significantly improve your chances of a successful pregnancy in the future. Remember, fertility is influenced by many factors, and it is essential to approach this journey with patience and support from healthcare professionals.

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