Dilatation and curettage, one of the most common minor surgical procedures in obstetrics and gynaecology, is linked with increased risk of preterm delivery, researchers have found.
The procedure, often shortened to D&C, is used mainly for miscarriage or terminations. Its use is declining in favour of less invasive medical methods, but it still remains common.
Dr Pim Ankum of the University of Amsterdam, the Netherlands, and colleagues analysed 21 studies included almost two million women. They found that a D&C performed in cases of miscarriage or induced abortion increases the chance of preterm birth (under 37 weeks) in a subsequent pregnancy by 29%, and of very preterm birth (under 32 weeks) by 69%.
Dr Ankum calls for more restrained use of D&C, which is still used for 50% of all miscarriages, particularly as preterm birth as "the biggest challenge in western obstetrics".
Findings were presented yesterday (16 June) at the European Society of Human Reproduction and Embryology’s 31st Annual Meeting held in Lisbon, Portugal.
Also at the meeting, Professor Nikolaos Polyzos of the Vrije Universiteit Brussels, Belgium, and colleagues carried out an analysis of all 161,967 ART treatment cycles in the UK between 2000 and 2012. This showed that the risk for future ectopic pregnancy after fertility treatment lowered over those 12 years, from 20 to 12 cases per 1,000.
Ectopic pregnancy – when an embryo implants outside the uterus – is slightly more likely following ART, but this study shows that the decrease in risk "appears strictly associated with the reduction in the incidence of tubal factor infertility and the transfer of fewer embryos". The team give credit to the UK’s National Chlamydia Screening Programme for reducing the rate of tubal factor infertility.
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