Hysteroscopy May Be the Method of Choice for Management of Residual Trophoblastic Tissue

Cohen, Shlomo B.; Kalter-Ferber, Anath; Weisz, Boaz; Zalel, Yaron; Seidman, Daniel S.; Mashiach, Shlomo; Lidor, Arie; Zolti, Mati; Goldenberg, Mordechai

doi:10.1016/s1074-3804(05)60577-4

Cited by 105 publications

(81 citation statements)

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“…Present study shows that rate of complication such as bleeding (22%), infection (10%), the risk of perforation (2.5%), cervical trauma (2.5%) and need for repeat evacuation due to persistent residual tissue was higher in suction evacuation group (5%). Whereas still higher rate of persistent residual tissue in patients who underwent Suction evacuation was seen in study of Shlomo B et al 9 Five (20.8%) patients who underwent traditional curettage later required operative hysteroscopy due to persistent residual tissue Hysteroscopy for RPOC has advantage as the procedure is done without anaesthesia, thereby preventing anaesthesia related complication. Even though procedure time is 2 min more compared to suction evacuation, the difference is statistically not significant (p 0.672).…”

Section: Discussionmentioning

confidence: 86%

Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception

Harish

Shwetha

Debnath

2018

Int J Reprod Contracept Obstet Gynecol

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Background: RPOC can occur due to spontaneous or induced abortion followed by incomplete or partial expulsion of product of conception. Suction evacuation is currently the standard surgical treatment, but operative hysteroscopy has the advantage over Suction evacuation allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications.Methods: Comparative retrospective study of 80 patients who presented with RPOC during the period of 6 months. Hysteroscopy was done in 40 patients and Suction evacuation in remaining 40 patients. Data regarding anaesthesia required, mean time taken for procedure and post procedure hospital stay, complication due to the procedure and post-operative outcome were collected to compared,Results: In hysteroscopy group none of patients required anaesthesia and even though mean time taken for the procedure is 2 minutes more in hysteroscopy group without statistical significant difference (P 0.672), the post procedure hospital stay is less compared to suction evacuation group. Complication due to procedure was seen in 5 (12.5%) patients in hysteroscopy group which is less compared to 13 (32.5%) patients in suction evacuation group. Mean number of days of pain requiring analgesia and Sick leave applied was also less in hysteroscopy group (1 day and 2 days respectively) group compared to suction evacuation group (9 days and 7 days respectively)Conclusions: Lesser rates of intra and post-operative complications with hysteroscopy makes the procedure ‘safe’ to the patients and ‘effective’ as it ensures complete evacuation of the uterine cavity under direct vision and reduce the need for repeat procedure.

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Section: Discussionmentioning

confidence: 86%

Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception

Harish

Shwetha

Debnath

2018

Int J Reprod Contracept Obstet Gynecol

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“…22 More strict criteria, however, were used in selecting candidates for hysteroscopy (eg, an obviously defined sonographic finding) than for re-evacuation.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Diagnosis of Retained Products of Conception After Dilation and Evacuation

Maslovitz

Almog

Mimouni

et al. 2004

J of Ultrasound Medicine

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Objective. Uterine re-evacuation samples taken in cases of suspected residua after curettage are occasionally negative for gestational tissue. We aimed at evaluating the occurrence of such postcurettage re-evacuation-negative samples and at exploring factors that may influence their occurrence. Methods. This was a cross-sectional comparative retrospective study of 69 consecutive women who underwent uterine re-evacuation for suspected postcurettage gestational remnants. Pathologic reports of samples drawn during re-evacuations were reviewed to determine whether the extracted tissue contained gestational tissue. The presence of factors that may influence the rate of a positive or negative sample (eg, sonographic findings, gestational age at initial procedure, and presenting symptom) was noted and compared between women with and without histologically verified remnants. Results. Twenty-eight (41%) of the re-evacuation samples were histopathologically positive for gestational remnants. Residual tissue was more commonly found when the initial evacuation was performed at a more advanced gestational age (>15 weeks). Women referred by emergency department attendants had significantly fewer positive samples. Normal expert sonographic examination practically excluded yielding samples. Conversely, no negative samples were preceded by sonographic reports mentioning residua. Conclusions. Most re-evacuation samples taken during a re-evacuation procedure for suspected residua are negative for gestational tissue. Parameters that are likely related to histologically confirmed gestational residual tissue are advanced gestational age at initial evacuation, level of the sonographer's skill, persistent bleeding as the presenting symptom, and a sonographic report specifically mentioning retained gestational tissue. Key words: abortion, recurettage, residua. t is not uncommon to encounter a woman with findings suggestive of remnants of conception within the endometrial cavity after a dilation and evacuation (D&E) procedure for termination of pregnancy or miscarriage. Irregular vaginal bleeding, abdominal cramps, amenorrhea, and fever with or without vaginal discharge are conditions consistent with residual content. Occasionally, such patients are asymptomatic and their condition is detected after incidental sonographic findings of residual tissue on a scan done for various indications.There are no clear-cut guidelines for the treatment of suspected remnants after curettage; hence, women suspected of having postabortion residua are treated according to local protocols, which include sonographic confirmation of the suspicion by an expert sonogra-

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“…Cohen et al compared selective curettage directed by hysteroscopy with conventional blind curettage in women with retained trofoblastic tissue. None of the women who underwent hysteroscopic selective curettage needed a second operation compared with 20.8% of the women who underwent traditional curettage [9].…”

Section: Introductionmentioning

confidence: 91%

Hysteroscopic resection of retained placental tissue: a feasibility study

Dankert

Vleugels

2007

Gynecol Surg

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Retained placental tissue (RPT) is a serious cause of secondary postpartum haemorrhage. Various surgical therapies are available with a variety of complications and disadvantages such as uterine perforation, blood transfusions, persisting RPT, recurrence in subsequent pregnancies or Asherman's syndrome. We describe 10 women who underwent hysteroscopic visualisation and resection of RPT. No complications occurred. RPT was histologically confirmed in 90%. No adhesions during a second-look hysteroscopy were seen. All women regained normal menstrual bleedings. Hysteroscopic selective resection of RPT should be considered in patients with secondary postpartum haemorrhage.

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Hysteroscopy May Be the Method of Choice for Management of Residual Trophoblastic Tissue

Cited by 105 publications

References 1 publication

Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception

Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception

Accuracy of Diagnosis of Retained Products of Conception After Dilation and Evacuation

Hysteroscopic resection of retained placental tissue: a feasibility study

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