STUDY QUESTION: Could dilatation and curettage (D_C), used in the treatment of miscarriage and termination of pregnancy, increase the risk of subsequent @entity600 ? SUMMARY ANSWER: A history of curettage in @entity1 is associated with an increased risk of @entity600 in a subsequent pregnancy compared with @entity1 without such history. WHAT IS KNOWN ALREADY: D_C is one of the most frequently performed procedures in obstetrics and gynaecology. Apart from the acknowledged but relatively rare adverse effects, such as cervical tears, @entity548 , infection, perforation of the uterus, bowel or bladder, or @entity5862 , D_C has been suggested to also lead to an increased risk of @entity600 in the subsequent pregnancy. STUDY DESIGN, SIZE, DURATION: In the absence of randomized data, we conducted a systematic review and meta-analysis of cohort and case-control studies. @entity1 /MATERIALS, SETTING, METHODS: We searched OVID MEDLINE and OVID EMBASE form inception until 21 May 2014. We selected cohort and case-control studies comparing subsequent @entity600 in @entity1 who had a D_C for first trimester miscarriage or termination of pregnancy and a control group of @entity1 without a history of D_C. MAIN RESULTS AND THE ROLE OF CHANCE: We included 21 studies reporting on 1 853 017 @entity1 . In @entity1 with a history of D_C compared with those with no such history, the odds ratio (OR) for @entity600 <37 weeks was 1.29 (95% CI 1.17; 1.42), while for very @entity600 the ORs were 1.69 (95% CI 1.20; 2.38) for <32 weeks and 1.68 (95% CI 1.47; 1.92) for <28 weeks. The risk remained increased when the control group was limited to @entity1 with a medically managed miscarriage or induced abortion (OR 1.19, 95% CI 1.10; 1.28). For @entity1 with a history of multiple D_Cs compared with those with no D_C, the OR for @entity600 (<37 weeks) was 1.74 (95% CI 1.10; 2.76). For spontaneous @entity600 , the OR was 1.44 (95% CI 1.22; 1.69) for a history of D_C compared with no such history. LIMITATIONS, REASONS FOR CAUTION: There were no randomized controlled trials comparing @entity1 with and without a history of D_C and subsequent @entity600 . As a consequence, confounding may be present since the included studies were either cohort or case-control studies, not all of which corrected the results for possible confounding factors. WIDER IMPLICATIONS OF THE FINDINGS: This meta-analysis shows that D_C is associated with an increased risk of subsequent @entity600 . The increased risk in association with multiple D_Cs indicates a causal relationship. Despite the fact that confounding cannot be excluded, these data warrant caution in the use of D_C for miscarriage and termination of pregnancy, the more so since less invasive options are available. STUDY FUNDING/COMPETING INTERESTS: This study was funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066.

Dilatation and curettage increases the risk of subsequent XXXX : a systematic review and meta-analysis.

@entity1 :: ('9606', 'Species') :: ['women', 'PARTICIPANTS'] @entity5862 :: ('MESH:D006175', 'Disease') :: ['Asherman syndrome'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity600 :: ('MESH:D000014', 'Disease') :: ['preterm birth']
@entity600 :: (MESH:D000014,Disease) :: ['preterm birth']
