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

Abstract

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.

Complications and reproductive outcome after uterine artery embolization for retained products of conception

“…RPOC is diagnosed on the basis of secondary PPH and US evaluation at a post‐partum examination. Recently, HR of RPOC was associated with improved reproductive outcomes compared with dilation and curettage . Therefore, we selected HR as the surgical treatment for RPOC.…”

Hysteroscopic management of retained products of conception: A systematic review

“…One study (Ganer-Herman et al, 2018) that reported live births per total number of patients in the study was excluded from the analysis. 24 Following RPOC treated with hysteroscopic resection, the overall random effects live birth rate was 87.3% (95% CI 83.4-91.2), and the magnitude of variability across studies was small (I 2 < 1%). The fixed effects pooled estimate for live birth rate in patients undergoing non-hysteroscopic operative management was 93.8% (89.6-98.0).…”

“…Of the included studies we found four which reported results of hysteroscopic management compared with a comparison group of suction curettage, 12,15,28,29 one with a comparison group of manual vacuum aspiration, 16 and 14 studies which had no comparison group. 10,11,[17][18][19][20][21][22][23][24][30][31][32][33] A summary of the included studies is presented in Tables 1a and 1b.…”

“…14 Several more studies on the topic have since been published, necessitating an updated review. [15][16][17][18][19][20][21][22][23][24]…”