Reproductive Outcomes After Hysteroscopic Resection of Retained Products of Conception

Ikhena, Deborah E.; Bortoletto, Pietro; Lawson, Angela K.; Confino, Rafael; Marsh, Erica E.; Milad, Magdy P.; Steinberg, Marissa L.; Confino, Edmond; Pavone, Mary Ellen

doi:10.1016/j.jmig.2016.07.010

Cited by 18 publications

(15 citation statements)

References 11 publications

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“…Smorgick et al 4 showed that women who were treated for RPOC were at risk for recurrent RPOC and placental problems in their subsequent pregnancies. However, placenta accreta was not diagnosed in the present study, two patients in UAE group and one in the control group had severe bleeding at (7,9,22) 5-54 (23) -Miscarriage 11 25 1-28 (7)(8)(9)12,22) 13-36 (15,23,24) 10-30 ( (21,22) 50-72 (15,23,24) 22 (15) Post-partum hemorrhage 25 17 6.8 (21) 7-25 (15,23,24) 4-13 (15,24) Placenta previa 13 0 -9-17 (23,24) 0.4-5 (15,24) Manual removal of placenta 25 17 13-37 (9,21) -0.3-2 (15) For categorical variables, results are presented as percentage. Abbreviations: UAE, uterine artery embolization; RPOC, retained products of conception; HR, hysteroscopic resection; HDP, hypertensive disorders of pregnancy.…”

Section: Discussioncontrasting

confidence: 63%

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

Ohmaru-Nakanishi

Kuramoto

Maehara

et al. 2019

J of Obstet and Gynaecol

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Aim The purpose of this study was to evaluate the complications and reproductive outcome after uterine artery embolization (UAE) for retained products of conception (RPOC). Methods This was a retrospective medical‐records review study of 57 women treated for RPOC. Participants were divided into two groups: women who underwent treatment with UAE (UAE group: n = 32, 56.1%) and those without UAE (control group: n = 25, 43.9%). The complications and reproductive outcomes were compared between the two groups. Information on subsequent pregnancies and their outcomes was available for 30 women who attempted to conceive. Results There were no significant differences in the interval from the last delivery or abortion (40.1 ± 3.4 vs 51.0 ± 5.1 months, respectively; P = 0.16), the rate of severe bleeding under hysteroscopy (18.5 vs 9.1%, respectively; P = 0.65), the conception rate (58.8 vs 61.5%, respectively; P = 1.0) and mean time to conception (9.9 ± 1.6 vs 11.0 ± 2.9 months, respectively; P = 0.17) in women in the UAE group compared with those in the control group. Rates of post‐partum hemorrhage (PPH) and manual removal of placenta (25.0% in the UAE group and 16.7% in the control group, respectively) were higher than the general population. Conclusion Selective UAE for RPOC may be a preferable procedure in women who are suspected as having a risk of severe bleeding under treatment. Women who were treated for RPOC, regardless of UAE, were at risk of PPH and difficulty in removing the placenta in future pregnancies.

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Section: Discussioncontrasting

confidence: 63%

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

Ohmaru-Nakanishi

Kuramoto

Maehara

et al. 2019

J of Obstet and Gynaecol

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“…Eight studies reported both surgical and postsurgical reproductive outcomes. Eight studies [2,16,17,19,22,24,26,33] reported surgical outcomes only, whereas 4 [5,25,29,30] evaluated only reproductive outcomes. Three studies included only RPOC after vaginal delivery (VD) or cesarean section (CS) [20,22,27].…”

Section: Study Characteristicsmentioning

confidence: 99%

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

Vitale

Parry

Carugno

et al. 2021

Journal of Minimally Invasive Gynecology

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Objective: To evaluate the impact of hysteroscopy for retained products of conception (RPOC) removal on surgical and reproductive outcomes. Data Sources: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, SciELO, EMBASE, and the Cochrane Central Register of Controlled Trials at the Cochrane Library) were searched from inception to March 2020. Methods of Study Selection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Medical Subject Headings terms and text words such as "retained products of conception," "placental remnants," "placenta," and "hysteroscopy" were used for the identification of relevant studies. We included observational and randomized studies that analyzed surgical and/or reproductive outcomes of women who underwent hysteroscopic removal of RPOC. The primary outcome was the complete resection rate after 1 procedure. Tabulation, Integration, and Results: Twenty out of 245 studies were applicable, with data provided for 2112 women. The pooled complete resection rate was 91% (95% confidence interval [CI], 0.83−0.96). The incomplete resection rate evaluated was 7% (95% CI, 0.03−0.14), with a complication rate of 2% (95% CI, 0.00−0.04). Out of 1478 procedures, only 12 cases (0.8%) of postsurgical intrauterine adhesions were reported. Regarding post-therapy fecundity, women attempting postoperative conception had a clinical pregnancy rate of 87% (95% CI, 0.75−0.95), with a live birth rate of 71% (95% CI, 0.60 −0.81) and a pregnancy loss rate of 9% (95% CI, 0.06−0.12). Conclusion: Hysteroscopy has a high rate of completely removing RPOC in a single surgical step, with low complication rates. Subsequent fecundity seems reassuring, with appropriate clinical pregnancy and live birth rates. However, standardization of approach and comparative trials of different hysteroscopic approaches are needed.

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“…The effect of RPOC and its treatment on fertility and pregnancy outcomes have been previously investigated. Ikhena et al [12] described a series of 111 patients who underwent hysteroscopic removal of RPOC, 55 of whom conceived afterwards and 38 achieved a live birth. A higher than normal rate of CD was demonstrated among study patients, as was the rate of abnormal placentation -18.1%, defined as placenta accreta, previa and retained placenta.…”

Section: Discussionmentioning

confidence: 99%

“…Literature regarding the reproductive outcomes following hysteroscopy versus curettage for RPOC is not lacking [10,11]. However, reports on pregnancies outcomes following hysteroscopic removal of RPOC are scarce [12]. Furthermore, only one report differentiates between RPOC following abortions and delivery [13], which may not necessarily pose the same risk for subsequent pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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

Herman

Kogan

Tairy

et al. 2018

Gynecol Obstet Invest

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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.

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Reproductive Outcomes After Hysteroscopic Resection of Retained Products of Conception

Cited by 18 publications

References 11 publications

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

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

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

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

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