IMR Press / CEOG / Volume 47 / Issue 4 / DOI: 10.31083/j.ceog.2020.04.5259
Open Access Original Research
Hysteroscopic removal of retained products of conception withenhanced vascularity: a study of reliability
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1 Obstetrics and Gynecology Department, Public Hospital of Lodi, Lodi, Italy
2 Public Hospital Palagi, Florence, Italy
Clin. Exp. Obstet. Gynecol. 2020, 47(4), 472–477; https://doi.org/10.31083/j.ceog.2020.04.5259
Submitted: 19 May 2019 | Accepted: 1 August 2019 | Published: 15 August 2020
Abstract

Purpose of Investigation: Retained products of conception (RPOC) is the leading cause of postpartum or post-abortion hemorrhage. RPOC showing high vascularity at ultrasound assessment (HV-RPOC) showed an enhanced hemorrhagic risk following blind surgical uterine emptying. The authors describe the clinical outcome of patients suffering from HV-RPOC undergoing hysteroscopic removal. Material and Methods: Cohort of symptomatic patients suffering from HV-RPOC following miscarriages, pregnancy terminations, and term deliveries. After ultrasound selection based on color-Doppler showing HV-RPOC, all patients underwent hysteroscopic resection. Results: Twenty-seven patients met the selection criteria. HV-RPOC were found in 14 and six women after first and second trimester pregnancy termination, respectively. In seven women RPOC were found after term delivery. In 18 women (66.6%) RPOC were found firmly adherent to myometrium. Neither intra- nor postoperative complications were recorded. Hysteroscopy follow-up was carried-out in 16 patients. Normal findings were found in 15 women, in one case a mild adhesion was observed. Conclusion: HV-RPOC are often characterized by abnormally adherent placenta, suggesting that an accreta can be an underlying etiology. A reliable management can be accomplished by hysteroscopic resection.

Keywords
Abnormally invasive placenta
Retained products of conception
Highly vascularized retained products of conception
Hysteroscopy
Placenta accreta
Post abortion hemorrhage
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