Yu F, Li Z, Wang Y, Yue Z, Zhong Y, Zeng L. Hysteroscopic morcellation for removal of persistent placental remnants in the uterine cornu: Two case reports.
Medicine (Baltimore) 2021;
100:e24097. [PMID:
33879654 PMCID:
PMC8078303 DOI:
10.1097/md.0000000000024097]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE
Hysteroscopic morcellation is an alternative approach for the removal of placental remnants, given its advantages of safety, efficiency and good reproductive outcomes. This superiority can be even more obvious for removing persistent placental remnants in the lateral angle of the uterine cavity after repeated dilation and curettage (D&C) of an angular pregnancy, which is rarely reported.
PATIENT CONCERNS
Two patients who were both initially misdiagnosed as having missed intrauterine miscarriages underwent repeated suction-assisted D&C procedures and were found to have persistent placental remnants in the lateral angles of the uterine cavity.
DIAGNOSES
Ultrasound and hysteroscopy evaluations showed that placental remnants in both cases were in the lateral uterine angles and protruding to the interstitial myometrium around the fallopian tube. We corrected the diagnosis to that of angular pregnancy according to a comprehensive consideration of the ultrasound, hysteroscopy and pathology results.
INTERVENTIONS
We performed MyoSure hysteroscopic morcellation for both patients and the placental remnants were removed completely without any complication.
OUTCOMES
The patients were both scheduled for a second-look hysteroscopy 1 to 3 months after surgery, which revealed normal morphology of the uterine cavities and tubal ostia. The patients both achieved normal intrauterine pregnancies several months after surgery.
LESSONS
Hysteroscopic morcellation is a good alternative approach for the removal of placental remnants and should be considered in cases in which there might be a high risk of incomplete evacuation or a high risk of uterine perforation, especially in cases of angular pregnancy.
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