Postpartum retained products of conception: Is it possible to avoid postpartum curettage?

• Published in: International journal of gynecology and obstetrics 2022-02, Vol.156 (2), p.231-235
• Main Authors: Nir, Arava, Mor, Matan, Yekutiel, Matar, Eisenberg, Neta, Smorgick, Noam
• Format: Article
• Language: English
• Subjects: Dilatation and Curettage - adverse effects; Female; Humans; hysteroscopy; Hysteroscopy - adverse effects; intrauterine adhesions; Postpartum Period; Pregnancy; residual trophoblastic tissue; retained products of conception; Retrospective Studies; suction curettage; Uterine Diseases - surgery
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.13696

Objective Removal of retained products of conception (RPOC) by suction curettage or hysteroscopy may be required in the postpartum period, possibly causing intrauterine adhesions. We investigated whether rates of suction curettage, hysteroscopy, and postoperative intrauterine adhesions have changed over time. Methods Parturients considered at risk for RPOC were followed in a specialized postpartum clinic with sequential ultrasound scans. We compared the rates of women requiring surgical procedures for RPOC removal and rates of postoperative intrauterine adhesions between two 2‐year periods: 2011–2012 (“early period”) and 2016–2017 (“late period”). Results The overall rates of women requiring a surgical procedure for removal of RPOC did not differ between the early and late periods (38/762 [5.0%] vs 41/732 [5.6%], respectively, P = 0.595). However, removal of RPOC by suction curettage decreased significantly over time whereas removal by hysteroscopy increased (P = 0.022). Intrauterine adhesions were diagnosed in 7 of 38 women (18.4%) who underwent a surgical procedure for RPOC removal in the early period, but none of the patients operated on in the late period developed intrauterine adhesions (P = 0.004). Conclusion Removal of RPOC in postpartum women may be completed by hysteroscopy in most cases, significantly reducing the need for postpartum curettage and the rates of postoperative intrauterine adhesions. Postpartum retained products of conception may be removed by hysteroscopy in most women, reducing the need for suction curettage and rates of postoperative intrauterine adhesions.