Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem

Study objective: To assess the efficacy and reproductive outcome of hysteroscopic removal of retained products of conception.

Design: Retrospective analysis (Canadian Task Force classification II-3).

Setting: Tertiary care university hospital.

Patients: One hundred fifty-nine patients were consecutively admitted to our department from July 2001 through August 2007 with a diagnosis of retained products of conception after medical abortion, dilation and evacuation, or delivery.

Interventions: Hysteroscopic removal of retained products of conception without the use of electrical energy.

Measurements and main results: Complete evacuation of the uterus was achieved in all patients. Trophoblastic tissue was histologically confirmed in 88%. All of the women regained normal menstrual bleeding. Complications occurred in 3 patients during or immediately after the procedure: pulmonary edema, sepsis and diffuse intravascular coagulopathy, and excessive bleeding, respectively. Of the 28 women who expressed a desire to become pregnant, 23 conceived. The conception rate was 82% (23 of 28), with a live-birth rate of 75% (21 of 28). Second-look hysteroscopy performed in 21 patients revealed no adhesions.

Conclusion: Hysteroscopic removal of retained products of conception is a simple and safe, and most probably the preferred procedure. It should be considered an alternative to conventional blind evacuation by curettage. It seems that this procedure preserves the integrity of the uterine cavity while averting additional trauma, and retains reproductive capacity. Further studies, including randomized controlled trials, may be necessary to confirm these results.