Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors?

Barel, Oshri; Krakov, Ayala; Pansky, Moty; Vaknin, Zvi; Halperin, Reuvit; Smorgick, Noam

doi:10.1016/j.fertnstert.2014.11.016

Cited by 54 publications

(51 citation statements)

References 11 publications

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“…In their series of 50 patients, surgical strategy did not cause any post-operative IUA [16]. Finally, we found 5 studies [17][18][19][20][21] investigating the role of suitable hysteroscopic surgery for retained products of conception (RPC) to prevent post-operative IUA formation ( Table 2). Four studies reported the outcomes of patients treated by surgical hysteroscopy alone [17][18][19]21] whilst one compared the outcomes of patients treated by surgical hysteroscopy with those treated with suction and curettage [20].…”

Section: Surgical Strategymentioning

confidence: 91%

“…We identified 8 studies [14][15][16][17][18][19][20][21] specifically focusing on application of a peculiar surgical techniques or instrumentation with the aim of preventing post-operative IUA.…”

Section: Surgical Strategymentioning

confidence: 99%

“…Finally, we found 5 studies [17][18][19][20][21] investigating the role of suitable hysteroscopic surgery for retained products of conception (RPC) to prevent post-operative IUA formation ( Table 2). Four studies reported the outcomes of patients treated by surgical hysteroscopy alone [17][18][19]21] whilst one compared the outcomes of patients treated by surgical hysteroscopy with those treated with suction and curettage [20]. A similar surgical technique was described in all 5 studies: hysteroscopic procedure consisted of a gentle, selective separation of the RPC from the underlying endometrium, with no or very limited use of electrosurgery in order to minimize thermal damage to the endometrium.…”

Section: Surgical Strategymentioning

confidence: 99%

“…The obtained data, for the most part, did not come from comparative studies (LE: 4) [17][18][19]21] and there was only one prospective study where a control group was used (LE: 2b) [20].…”

Section: Surgical Strategymentioning

confidence: 99%

See 3 more Smart Citations

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Sardo

Calagna

Scognamiglio

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

120

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Section: Surgical Strategymentioning

confidence: 91%

Section: Surgical Strategymentioning

confidence: 99%

Section: Surgical Strategymentioning

confidence: 99%

“…The obtained data, for the most part, did not come from comparative studies (LE: 4) [17][18][19]21] and there was only one prospective study where a control group was used (LE: 2b) [20].…”

Section: Surgical Strategymentioning

confidence: 99%

See 2 more Smart Citations

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Sardo

Calagna

Scognamiglio

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

120

View full text Add to dashboard Cite

“…While most series report an incidence of 1%, some prospective studies report an incidence of up to 6% [1]. Vaginal bleeding is the most common symptom [2], but patients may also present with pain, infectious signs or even subsequent hypomenorrhea and infertility due to intrauterine adhesions [3,4]. Others may remain asymptomatic and are diagnosed as part of routine sonographic follow-up.…”

Section: Introductionmentioning

confidence: 99%

Pregnancies Following Hysteroscopic Removal of Retained Products of Conception after Delivery Versus Abortion

Herman

Kogan

Tairy

et al. 2018

Gynecol Obstet Invest

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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.

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Postpartum retained products of conception: Is it possible to avoid postpartum curettage?

Nir

Mor

Yekutiel

et al. 2021

Intl J Gynecology & Obste

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Retained products of conception (RPOC) occur in up to 1% of deliveries. 1 Although uncommon, surgical procedures for removal of RPOC may be required in these parturients, associated with the long-term sequelae of intrauterine adhesions, abnormal placentation, and infertility. 2,3 Consequently, Asherman's syndrome following postpartum surgical procedures for removal of RPOC has emerged as a major cause for litigation. 4 With the aim of optimizing the postpartum management of women considered at risk for RPOC while reducing the rates of surgical interventions for RPOC removal, we previously described a postpartum clinical and ultrasound follow-up protocol, whereby women considered at risk for RPOC underwent sequential ultrasound scans. 5,6 In cases of persistent abnormal ultrasound findings suspicious for RPOC between 6 and 8 weeks from delivery, hysteroscopy for diagnosis and RPOC removal was offered. However, some women required earlier surgical interventions, by hysteroscopy or by suction curettage, because of

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Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors?

Cited by 54 publications

References 11 publications

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Pregnancies Following Hysteroscopic Removal of Retained Products of Conception after Delivery Versus Abortion

Postpartum retained products of conception: Is it possible to avoid postpartum curettage?

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