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. 2019 Sep;11(3):217-222.

Hysteroscopic management of retained products of conception: A single center observational study

L Alonso Pacheco  1 , D Timmons  2 , M Saad Naguib  2 , J Carugno  2
Affiliations

Hysteroscopic management of retained products of conception: A single center observational study

L Alonso Pacheco et al. Facts Views Vis Obgyn. 2019 Sep.

Abstract

Background: Retained products of conception (RPOC) are defined as the presence of tissue inside the uterine cavity after delivery or termination of a pregnancy. Operative hysteroscopy is associated with increased surgical success and decreased postoperative formation of intrauterine adhesions. The aim of this study is to report our experience in hysteroscopic management of RPOC.

Methods: A retrospective chart review identified patients who underwent hysteroscopic removal of retained products of conception at a single center (n=45). Basic demographic data, surgical findings and applied technique were reviewed. Chi Square and independent samples t-tests were performed when appropriate. A significance level of p<0.05 was accounted.

Results: Of all cases included, 64% were the result of a spontaneous or elective abortion and 47% were from patients who had failed previous treatment. Previous medical or surgical treatment was observed in 37.9% of patients labeled as type 0-1 versus 62.5% of type 2-3 (p=0.1138). The timing between the end of the preceding pregnancy and hysteroscopic removal was in average 2.62 months in type 0-1 compared to 1.7 months in type 2-3 (p=0.1068). All patients who were classified as type 2-3 required the use of monopolar energy during the surgery, compared to zero patients who were classified as type 0-1 (p < 0.0001).

Conclusion: Operative hysteroscopy remains a safe and highly effective option for the management of RPOC and should be the preferred method compared to traditional dilatation and suction curettage.

Keywords: Doppler Ultrasound; Gutenberg Classification; Hysteroscopy; Retained Products of Conception.

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Figures

Figure 1
Figure 1
Ultrasonographic patterns of RPOC. Gutenberg Classification. A- Type 0: hyperechogenic avascular mass. B-Type 1: Different echoes with minimal or no vascularization. C- Type 2: Highly vascularized mass confined to the cavity. D- Type 3: Highly vascularized mass with highly vascularized endometrium.
Figure 2
Figure 2
Hysteroscopic patterns of RPOC. Gutenberg classification. A- Type 0: white mass in with no clear structures. B- Type 1: well-defined avascular chorionic villi. C- Type 2: Well Vascularized chorionic villi. D- Fig 4: Aneurism over myometrium in the implantation area.
Figure 3
Figure 3
Detailed view of the loop used as curette.
Figure 4
Figure 4
Implantation area after resection.
See this image and copyright information in PMC

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