Hysteroscopic removal of retained products of conception in the outpatient setting

Abstract

This article presents an overview of the diagnosis and classification of retained products of conception (RPOC) as well as removal techniques and discusses the associated complications, advantages and disadvantages of these procedures. RPOC occur when tissue from the placenta or the fetus remain in the uterus after all types of termination of pregnancy and deliveries, including vaginal or cesarean delivery, spontaneous miscarriage, or induced medical or surgical abortion. The diagnosis is based on the combination of clinical findings and ultrasound (US) evaluation (gray-scale and Doppler flow). Hysteroscopy has emerged as the preferred treatment for women with RPOC largely due to its demonstrated safety, feasibility, low incidence of postoperative intrauterine adhesions (IUAs) and high rates of subsequent fertility. Furthermore, thanks to the availability of hysteroscopic tissue removal systems (HTRs) and the miniresectoscope, many hysteroscopic procedures can now be performed without anaesthesia or cervical dilation in an ambulatory setting. Further studies are required to provide a more comprehensive understanding of the reproductive outcomes in patients with pregnancies complicated by RPOC.