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Aim: To compare clinical variables, sonographic findings and pregnancy outcomes following the hysteroscopic removal of retained products of conception (RPOC) after delivery and abortion. Methods: This is a retrospective cohort of operative hysteroscopies performed between 2011 and 2015 for suspected RPOC, during which trophoblastic tissue was obtained. Patient demographics, clinical presentation, sonographic evaluation, subsequent infertility and pregnancy outcomes were compared between post-delivery (n = 85) and post-abortion (n = 93) cases. Results: The main presenting symptom in both study groups was vaginal bleeding. On sonographic evaluation, maximal endometrial thickness was significantly higher in the post-delivery group, while irregularity and increased flow were more common in the post-abortion group. There was a similar rate of deliveries following hysteroscopy in both groups with 40% in the post-delivery group and 39.7% in the post-abortion group. Deliveries in the post-delivery group were characterized by a higher rate of abnormal placentation – 30.5% – including low lying placenta and placenta accreta. A significant rate of vaginal deliveries in both groups entailed manual removal of the placenta or exploration of the uterine cavity (23.5 and 10.5%, p = 0.20). Conclusion: Pregnancies following RPOC after delivery entail a higher rate of abnormal placentation.

(Int J Gynaecol Obstet. 2017;138(1):84–88) Trial of labor after cesarean (TOLAC) is often discouraged because of increased risk of adverse maternal and perinatal outcomes. However, few studies have focused on TOLAC with a subgroup of women with gestational diabetes mellitus (GDM), which is known to complicate pregnancies, for example increased risk of neonatal respiratory distress syndrome. In the present study, authors assess rates of TOLAC and subsequent vaginal birth after cesarean (VBAC) among women with GDM and identify associated factors.

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