Design: Mixed methods study.

Setting: Minimally invasive gynecology (MIGS) academic practice.

Patients or Participants: Patients were identified who underwent treatment of IUA as a result of an HRPE.

Interventions: Demographic and history data were obtained from chart review. A MIGS surgeon conducted ten interviews which were audio-recorded and transcribed; the transcripts were coded in NVivo 14. The MIGS surgeon developed a counseling intervention based on the interview data and led a multisite Consortium of MIGS Specialists for the Early Diagnosis of Ashermans Syndrome (COMEDAS), where the interview data and counseling intervention script were reviewed by eight MIGS specialists.

Measurements and Main Results: 90% of patients who experienced an HRPE reported that they were never counseled about their risk of IUA at the time of the HRPE. All patients would have preferred early counseling including information regarding frequency, symptoms, risks, and treatment of IUA. 90% of patients would have wanted to receive counseling when giving consent for the HRPE, or, if the HRPE occurred emergently during delivery, prior to hospital discharge. Patients experienced delay in diagnosis and subsequent pregnancy as well as repetitive dismissal by clinicians. Patients emphasized the emotional challenges of seeking IUA diagnosis and treatment and expressed frustration at the lack of empowerment and autonomy in their reproductive healthcare.

Conclusion: Patients have a clear desire for improved counseling regarding IUA after HRPE. Based on this data, a counseling intervention has been developed which is currently being validated in Phase 2 of this multisite FPRN study.