A “See and Treat” Office Procedure for Retained Products of Conception Removal After Normal Vaginal Delivery Using Manual Vacuum Aspiration: Preliminary Efficacy and Reproductive Outcomes

Karavani, Gilad; Bahar, Raz; Herzberg, Shmuel; Yanai, N.

doi:10.1016/j.jmig.2017.06.008

Cited by 6 publications

(9 citation statements)

References 24 publications

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“…However, most of the available data focused on comparing operative hysteroscopy and dilation and curettage. [6][7][8]10,11,[17][18][19][20] Jiménez et al published one of the first reports describing the application of the see-and-treat approach for the management of RPOC in 2009. 16 Recently, Jakopic ˇMac ˇek et al reported one of the most extensive series of patients with RPOC managed with the see-and-treat approach by office hysteroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Advantages of this approach over dilation and curettage have been demonstrated in several studies. However, most of the available data focused on comparing operative hysteroscopy and dilation and curettage 6–8,10,11,17–20 . Jiménez et al published one of the first reports describing the application of the see‐and‐treat approach for the management of RPOC in 2009 16 .…”

Section: Discussionmentioning

confidence: 99%

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See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study

Raz

Sigal

Arjona

et al. 2022

J of Obstet and Gynaecol

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Aim To compare the efficacy and safety of in‐office hysteroscopy with a see‐and‐treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC). Methods We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see‐and‐treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records. Results Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in‐office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58). Conclusions In‐office hysteroscopy with the see‐and‐treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In‐office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study

Raz

Sigal

Arjona

et al. 2022

J of Obstet and Gynaecol

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“…These include visually-directed endometrial sampling, lysis of intrauterine or cervical adhesions, and removal of numerous pathologies, such as endometrial and endocervical polyps, small leiomyomas, retained products of conception and intrauterine devices. 17–19…”

Section: Indications For Office Hysteroscopymentioning

confidence: 99%

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

Orlando

Bradley

2022

Obstetrics &Amp; Gynecology

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Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, mu ¨llerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.

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“…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.…”

Section: Overview Of Included Studiesmentioning

confidence: 99%

“…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]…”

mentioning

confidence: 99%

Hysteroscopic management of retained products of conception: A systematic review

Taylor

Ellett

Hiscock

et al. 2021

Aust NZ J Obst Gynaeco

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Retained products of conception (RPOC) present a common diagnostic and management dilemma due to a lack of evidence-based diagnostic criteria and management guidelines. RPOC can complicate surgical or medical termination of pregnancy (TOP), miscarriage and vaginal or caesarean delivery. 1 The incidence is reported at approximately 1% 1-3 but may be higher. 1 Treatment of RPOC is recommended to manage bleeding and infection and prevent long-term reproductive complications. 4,5 Traditionally, dilatation and curettage has been the mainstay treatment, with either suction catheter or manual curette, though medical management with misoprostol is also commonly prescribed. 6,7 Curettage is generally considered a safe procedure, but

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A “See and Treat” Office Procedure for Retained Products of Conception Removal After Normal Vaginal Delivery Using Manual Vacuum Aspiration: Preliminary Efficacy and Reproductive Outcomes

Cited by 6 publications

References 24 publications

See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study

See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

Hysteroscopic management of retained products of conception: A systematic review

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