Full length articleRetained products of conception: What is the risk for recurrence on subsequent pregnancies?☆
Introduction
Retained products of conception (RPOC) occur in up to 3% of all deliveries and abortions [1]. The treatment of RPOC includes uterine cavity evacuation by suction curettage or, increasingly, by operative hysteroscopy or hysteroscopic morcellation [[2], [3], [4]]. Both surgical techniques are associated with the long-term complications of intrauterine adhesions, which may cause traumatic amenorrhea, infertility, recurrent abortions and abnormal placentation [5]. However, the rates of post-surgical intrauterine adhesions differ between women treated by suction curettage compared with those managed by operative hysteroscopy. While intrauterine adhesions have been reported in up to 40–60% of women following curettage for RPOC, the rate of intrauterine adhesions following hysteroscopy is much lower, i.e., around 7–10% [[2], [6], [7], [8]]. The difference in the rates of intrauterine adhesions may be explained by the targeted and limited hysteroscopic removal as opposed to the global and “blind” uterine cavity curettage.
In view of the possible injury to the endometrium by the RPOC and by the surgical procedure used to remove them, the reproductive outcomes of these patients’ subsequent pregnancies could be compromised. In particular, there may be increased risk for placental problems due to abnormal placentation, such as placenta accreta, retained placenta and recurrent RPOC. To date, several studies have investigated the reproductive outcomes of patients treated for RPOC. Ikhena et al. [9] followed 111 patients treated hysteroscopically for RPOC and reported that abnormal placentation (including placenta previa, placenta accreta and retained placenta) was present in 18.1% of those patients’ subsequent pregnancies. Sonnier et al. [10] reported a conception rate of 71.1% at 6 months and 83.5% at 12 months among 53 patients treated hysteroscopically for RPOC. Ben Ami et al. [11] compared the reproductive outcomes of women with RPOC treated by dilatation and curettage (D&C) and hysteroscopy. They found that hysteroscopy was associated with a shorter mean time to further conception. None of those studies investigated the rates of recurrent RPOC, which could be increased in these women due to their potential endometrial injury. This information is of clinical importance since appropriate ultrasound postpartum follow-up may be offered to women who are at increased risk for RPOC.
The aim of this study is to determine the risk for recurrent RPOC and placental problems on subsequent pregnancies of women surgically treated for RPOC, and to compare this risk between women who underwent hysteroscopic removal versus removal by suction curettage.
Section snippets
Materials and methods
For this retrospective cohort study, we conducted a computerized search for all cases treated for RPOC in our institution between January 2008 and December 2015, using the ICD-9 codes 667.10–667.14 (retained portion of placenta or membranes). This study period was chosen because hysteroscopy became the main surgical approach for treatment of RPOC at that time. The medical records of all identified cases were retrospectively reviewed. We retrieved the information on demographics, medical
Results
A total of 442 women were operated for RPOC removal in our department during the study period. Their demographic, obstetric and surgical characteristics are presented in Table 1. Information on subsequent pregnancies was available in the medical records for 161 (36.4%) of those women. Comparisons of the baseline characteristics for women with and without information on subsequent pregnancies are shown in Table 1. No statistically significant differences were detected between those two groups in
Comment
RPOC may occur following delivery or abortion and necessitate surgical procedures for uterine cavity evacuation, often causing intrauterine adhesions, which could lead to infertility, recurrent abortions and abnormal placentation in subsequent pregnancies [5]. In the current study, the overall rate of deliveries among women treated for RPOC with available information on their subsequent pregnancies was high, reaching >90%. Nevertheless, those women are at risk for placental problems, including
Conflicts of interest
The authors have no conflict of interest to disclose.
References (11)
- et al.
Hysteroscopic management of retained products of conception: meta-analysis and literature review
Eur J Obstet Gynecol Reprod Biol
(2014) - et al.
Hysteroscopic morcellation versus loop resection for removal of placental remnants: a randomized trial
J Minim Invasive Gynecol
(2016) - et al.
Removal of retained adherent placental remnants using the hysteroscopy endo-operative system
J Minim Invasive Gynecol
(2016) - et al.
Asherman syndrome–one century later
Fertil Steril
(2008) - et al.
Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors
Fertil Steril
(2015)
Cited by (0)
- ☆
Part of this publication was performed to fulfill the MD thesis requirements of the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.