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Wagenaar LP, van Vugt WLJ, Huppelschoten AG, Radder CM, Peters LW, Weyers S, van Wessel S, Schoot BC, Hamerlynck TWO, van Vliet HA. Reproductive and obstetrical outcomes after treatment of retained products of conception: hysteroscopic removal vs ultrasound-guided electric vacuum aspiration, a prospective follow-up study. Am J Obstet Gynecol 2024; 231:233.e1-233.e8. [PMID: 38521232 DOI: 10.1016/j.ajog.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Traditionally, curettage has been the most widely performed surgical intervention for removing retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative because of the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetrical outcomes were limited, and data conflicting. OBJECTIVE This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. STUDY DESIGN This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. RESULTS A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P=.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P=.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P=.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P=1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0-17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0-12.1) in the electric vacuum aspiration group (P=.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P=.350). CONCLUSION Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.
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Affiliation(s)
- Liselot P Wagenaar
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands.
| | - Wouter L J van Vugt
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Celine M Radder
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
| | - Louisette W Peters
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Benedictus C Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Tjalina W O Hamerlynck
- Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Huib A van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Wagenaar LP, Hamerlynck TW, Radder CM, Peters LW, Weyers S, Schoot BC, van Vliet HA. Hysteroscopic morcellation vs. curettage for removal of retained products of conception: a multicenter randomized controlled trial. Fertil Steril 2023; 120:1243-1251. [PMID: 37657600 DOI: 10.1016/j.fertnstert.2023.08.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications. DESIGN A randomized controlled, nonblinded trial. SETTING Three teaching hospitals and one university hospital from April 2015 to June 2022. PATIENTS A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration. INTERVENTION Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible. MAIN OUTCOME MEASURES In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs. RESULTS Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively). CONCLUSION In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments. CLINICAL TRIAL REGISTRATION NUMBER NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015.
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Affiliation(s)
- Liselot P Wagenaar
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands.
| | - Tjalina W Hamerlynck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Celine M Radder
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Louisette W Peters
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Steven Weyers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Benedictus C Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Huib A van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, The Netherlands; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Wagenaar LP, van Vliet HA, Radder CM, Peters LW, Weyers S, Schoot BC, Hamerlynck TW. Operative hysteroscopy versus ultrasound-guided electric vacuum aspiration for removal of retained products of conception: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100230. [PMID: 37701632 PMCID: PMC10493502 DOI: 10.1016/j.eurox.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives To compare intrauterine adhesion (IUA) formation after hysteroscopic removal (HR) of retained products of conception (RPOC) with IUA formation after ultrasound-guided electric vacuum aspiration (EVA) and externally validate the outcomes of an RCT. Study design This prospective cohort study was conducted from April 2015 until June 2022 in 2 Dutch teaching hospitals and one Belgian university hospital. Women opting for EVA underwent the procedure as soon as possible. In the HR group, the therapeutic hysteroscopy was performed at least eight weeks after the end of pregnancy. Postoperatively, an office second-look hysteroscopy was offered to all patients. Women were included if they had been diagnosed with RPOC ranging from 1 to 4 cm on ultrasound and did not want to participate in the RCT. EVA was performed using a Karman cannula. Operative hysteroscopy consisted either of hysteroscopic morcellation with the TruClear™ System or the Intrauterine BIGATTI Shaver or cold loop resection with a bipolar resectoscope. Results Of 178 included women, 124 were treated with HR and 28 with EVA. Outcomes of HR and EVA did not differ significantly in terms of complications (5.6 % vs 3.6 %; p = 1.00). Second-look hysteroscopy showed IUAs in 14 of 91 women (15.4 %) after HR and in 1 of 16 (6.3 %) after EVA (p = .461). Completeness of removal was significantly higher (90.1 %) after HR than after EVA (68.8 %) (p = .035). Additional operative hysteroscopy was required in 14.3 % of the HR group versus 37.5 % in the EVA group (p = .036). Conclusion In our cohort study, no significant differences in IUAs or complications were found. RPOC removal with HR was more often complete than removal with EVA, and additional therapeutic hysteroscopy was less frequently required after HR. These findings need to be correlated with those of RCTs. Clinical trial registration The study was registered in de Dutch Trial Register (NTR4923). Date of registration 23-11-2014. Date of first enrollment 01-01-2015. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923.
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Affiliation(s)
- Liselot P. Wagenaar
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Hubertus A. van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Celine M. Radder
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Louisette W. Peters
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Steven Weyers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Women’s Clinic, Ghent University Hospital, Ghent, Belgium
| | - Benedictus C. Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Tjalina W. Hamerlynck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Women’s Clinic, Ghent University Hospital, Ghent, Belgium
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Bailón Queiruga M, Olivé LM, Redol AC, Trigo CA, Betbesé EM, González MS. Outpatient hysteroscopic removal of retained products of conception: evaluation of effectiveness, safety and patient satisfaction. Eur J Obstet Gynecol Reprod Biol 2023; 290:123-127. [PMID: 37783140 DOI: 10.1016/j.ejogrb.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To assess effectiveness, safety and patient satisfaction of hysteroscopic removal of retained products of conception using a tissue removal system in the outpatient setting. STUDY DESIGN A prospective observational study was carried out in a tertiary care hospital over a 10-month period. Fifty-two women who underwent an outpatient hysteroscopy for removal of retained products of conception were included. Effectiveness was evaluated as complete removal of retained products of conception in a one-time procedure. Safety was determined based on the rate of complications using the Clavien-Dindo classification system. Patient satisfaction and pain were assessed using a visual analogue scale survey completed by patients after the procedure. RESULTS Complete removal of retained products of conception in a one-time procedure was achieved in 98.1% of cases. The mean morcellation time was 6.0 min. The complication rate recorded in this study was 9.6%; most complications were mild, but there was one case of uterine perforation. A global satisfaction ratio of 8.9 out of 10 was reported by patients. The study did not find any significant differences in complete removal of retained products of conception based on type of hysteroscope, presence of symptoms or Gutenberg classification. Although not significant, a linear relationship was observed between a higher volume of retained products of conception and a higher Gutenberg classification (p=0.229). CONCLUSION Outpatient management of retained products of conception using a tissue removal system is effective and safe, and has a high level of patient satisfaction. The results of this study have the potential to alter the standard approach to the management of retained products of conception.
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Affiliation(s)
- Marta Bailón Queiruga
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain.
| | - Laura Melé Olivé
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Ana Calvo Redol
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain; Department of Obstetrics and Gynaecology, University of Lleida, Lleida, Spain
| | - Claudia Amés Trigo
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Elvira Mestres Betbesé
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Marta Simó González
- Department of Obstetrics and Gynaecology, Arnau de Vilanova University Hospital, Lleida, Spain; Department of Obstetrics and Gynaecology, University of Lleida, Lleida, Spain
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Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Panel P, Raiffort C, Giraudet G, Bussières L, Fauconnier A. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA 2023; 329:1197-1205. [PMID: 37039805 PMCID: PMC10091175 DOI: 10.1001/jama.2023.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obstetrics, APHP, Hopital Lariboisière, University of Paris Cité, Paris, France
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
| | - Hocine Drioueche
- Department of Clinical Research, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Martin Koskas
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, Marseille CEDEX 5, France
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes CEDEX 2, France
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand CEDEX 1, Faculty of Medicine, ISIT – Université d’Auvergne, Clermont-Ferrand, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France
- Centre for Epidemiology and Population Health-INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, Poitiers, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, Reims, France
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d’Angers, Angers CEDEX 01, France
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, University of Paris Cité, Paris, France
| | - Géraldine Giraudet
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
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de Codt M, Jadoul P, Luyckx M, Squifflet JL, Dolmans MM, Maillard C, Baurain JF, Marbaix E, Gerday A. Hysteroscopic management of molar pregnancy: A series of 36 cases. Rare Tumors 2023; 15:20363613231168767. [PMID: 37035475 PMCID: PMC10074611 DOI: 10.1177/20363613231168767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Hydatidiform Mole (HM) is the most common form of gestational trophoblastic disease. Dilatation and curettage is the classical treatment of this affection. Hysteroscopic resection (HsR) is an alternative for the treatment of intra-uterine pathology. Objective: To describe the feasibility of HsR for the management of HM. Result: Case series of patients who had a complete or partial HM confirmed by histological examination of the trophoblastic tissue resected by operative hysteroscopy between 2007 and 2019. After approval of our ethics committee, we evaluated 36 patients who underwent hysteroscopic resection for molar pregnancy. Histological analysis showed partial HM in 28 patients (77.8%) and complete HM in 8 (22.2%). Main surgical complications were uterine perforation in one patient and glycine resorption in 10 patients with two cases of hyponatremia corrected by standard treatment. We performed an ultrasound control 1 month after the intervention in 19 patients (52.8%) as they had slow decrease of HCG or bleeding complaints and found retained product of conception (RPOC) in six patients (16.7%). Conclusion: This first report on a small number of patients demonstrate that hysteroscopic resection is a feasible procedure for the management of molar pregnancy. Direct visualization of the procedure helps the surgeon to control the resection. Further studies are mandatory to compare this technique with D&C in term of RPOC and fertility outcomes as it remains the standard treatment.
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Affiliation(s)
- Matthieu de Codt
- Department of Gynecology, Centre Hospitalier Universitaire Namur-Godinne, Namur, Belgium
| | - Pascale Jadoul
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mathieu Luyckx
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut Roi Albert 2- IRA2, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Luc Squifflet
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut Roi Albert 2- IRA2, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Charlotte Maillard
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-François Baurain
- Institut Roi Albert 2- IRA2, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Department of Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Etienne Marbaix
- Department of Anatomic Pathology, Cliniques Universitaires Saint-Luc, and de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Amandine Gerday
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut Roi Albert 2- IRA2, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Hooker AB, de Leeuw RA, Emanuel MH, Mijatovic V, Brolmann HAM, Huirne JA. The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature. BMC Pregnancy Childbirth 2022; 22:837. [PMID: 36376829 PMCID: PMC9664654 DOI: 10.1186/s12884-022-05164-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Intrauterine adhesions (IUAs) are one of the main reproductive system diseases in women worldwide. Fusion between the injured opposing walls leads to partial-to-complete obliteration of the cavity and/or cervical canal. The main clinical manifestations in case of IUAs are menstrual disturbances, cyclic pain and reproductive disorders. The reproductive outcomes of women with IUAs remain limited and inefficient compared to women without IUAs, even after adhesiolysis. An exact understanding of the underlying mechanisms and processes to explain the compromised reproductive performance and outcomes in case of IUAs are lacking. Methods A systematic literature review of MEDLINE-PubMed (1966 to January 2022) and EMBASE (1974 to January 2022) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported underlying causes, related mechanisms and processes to explain the association between IUAs and impaired reproductive performance, pregnancy and obstetric complications. Results After an extensive review of the literature, 58 articles were identified reporting underlying mechanisms to explain the association between IUAs and impaired fertility. Intrauterine scarring influences the process of fertilization, reproductive performance and ultimately reproductive outcome. IUAs can disturb the cervico-utero-tubal sperm transport and result in an avascular and unresponsive endometrium with decreased receptivity and thickness. Abnormal decidualization and abnormal trophoblastic infiltration leads to placental attachment disorders. Moreover, the risk for premature delivery, intrauterine fetal growth restriction and fetal anomalies is increased in case of IUAs. Conclusion The impact of IUAs on reproductive performance, even after adhesiolysis, is becoming more apparent. The postulated mechanisms to explain the association are related to sperm transport, embryo implantation and placentation. Prevention, by preserving the basal layer of the endometrium is essential. Effective and evidence-based strategies for the prevention of endometrial injury and formation of IUAs, are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05164-2.
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Mathieu E, Riethmuller D, Delouche A, Sicot M, Teyssier Y, Finas M, Guillaume B, Thony F, Ferretti G, Ghelfi J. Management of Symptomatic Vascularized Retained Products of Conception by Proximal Uterine Artery Embolization with Gelatin Sponge Torpedoes. J Vasc Interv Radiol 2022; 33:1313-1320. [PMID: 35868595 DOI: 10.1016/j.jvir.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of temporary proximal uterine artery embolization (UAE) for the treatment of highly vascularized retained products of conception (RPOCs). MATERIALS AND METHODS This retrospective analysis included women who underwent treatment for vaginal bleeding after abortion, miscarriage, or delivery, with highly vascularized RPOCs detected by Doppler ultrasound (US) (ie, presence of an enhanced myometrial vascularity, a low resistance index of <0.5, and a peak systolic velocity of ≥0.7 m/s). A unilateral or bilateral embolization with torpedoes of gelatin foam was performed. From November 2017 to January 2021, 24 women with a median age of 30 years (interquartile range, 26.0-34.5 years) with symptomatic highly vascularized RPOCs were included. Clinical success was defined as bleeding arrest between the UAE and 1-month follow-up. Technical success was defined as the complete obstruction of at least 1 uterine artery supplying vascular abnormalities. The safety of the procedure according to the classification of the Society of Interventional Radiology and evolution of lesions on US were also reported. RESULTS Technical success was achieved in all 24 (100%) patients, with bilateral arterial embolization in 19 (79%) patients and unilateral embolization in 5 (21%) patients. Clinical success was achieved in all 24 (100%) patients. Five patients still had uterine retention at the 1-month follow-up, including 2 patients with highly vascularized RPOCs. Two patients benefited from hysteroscopy, and 3 had noninvasive management. Four minor adverse events were reported (1 patient had infectious endometritis and 3 patients had a postembolization syndrome). CONCLUSIONS Proximal UAE with torpedoes of gelatin foam is safe and effective for the management of symptomatic highly vascularized RPOCs.
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Affiliation(s)
- Eliott Mathieu
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Didier Riethmuller
- University of Grenoble Alpes, Grenoble, France; Department of Obstetrics and Gynecology, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélie Delouche
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Sicot
- Department of Obstetrics and Gynecology, Grenoble Alpes University Hospital, Grenoble, France
| | - Yann Teyssier
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Mathieu Finas
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bénédicte Guillaume
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Frederic Thony
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Gilbert Ferretti
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Ghelfi
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France; INSERM U1209/CNRS UMR 5309, Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France.
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9
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Herzberg S, Ezra Y, Haj Yahya R, Weiniger CF, Hochler H, Kabiri D. Long-term gynecological complications after conservative treatment of placenta accreta spectrum. Front Med (Lausanne) 2022; 9:992215. [DOI: 10.3389/fmed.2022.992215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine the association between conservative treatment for PAS (placenta accreta spectrum) and subsequent gynecological and fertility complications.MethodsAll women who underwent conservative treatment for PAS between January 1990 and December 2000 were included in this retrospective cohort study conducted in a tertiary teaching hospital. Gynecological and fertility complications experienced after the index delivery were collected from the medical records and telephone questionnaires. This data was compared to an age and parity-matched control group of women without PAS.ResultsThe study group included 134 women with PAS managed conservatively and 134 controls with normal deliveries matched by parity and age. Women in the PAS group required significantly more postpartum operative procedures such as hysteroscopy or D&C (OR = 6.6; 95%CI: 3.36–13.28; P = <0.001). Following the index delivery, there were 345 pregnancies among 107 women who attempted conception following conservative treatment for PAS vs. 339 pregnancies among 105 women who attempted conception in the control group. Among women who attempted conception following conservative treatment for PAS 99 (92.5%) delivered live newborns (a total of 280 deliveries) vs. 94 (89.5%) in the control group, (a total of 270 live newborns, p = 0.21). The need for fertility treatments was not different between the two groups (OR = 1.22; 95%CI: 0.51–2.93; P = 0.66).ConclusionAfter conservative treatment for PAS, significantly more women required complementary procedures due to retained placenta and/or heavy vaginal bleeding. There was no evidence of fertility impairment in women post-conservative treatment for PAS.
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10
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Raz N, Sigal E, Gonzalez Arjona F, Calidona C, Garzon S, Uccella S, Laganà AS, Haimovich S. See-and-treat in-office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study. J Obstet Gynaecol Res 2022; 48:2459-2465. [PMID: 35698805 PMCID: PMC9541046 DOI: 10.1111/jog.15327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
AIM To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC). METHODS We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see-and-treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records. RESULTS Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in-office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58). CONCLUSIONS In-office hysteroscopy with the see-and-treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In-office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.
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Affiliation(s)
- Nili Raz
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emiliya Sigal
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Fernando Gonzalez Arjona
- Department of Obstetrics and Gynecology, Hospital Regional Materno Infantil de Alta Especialidad, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Carmelo Calidona
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Hysteroscopy Unit. Del Mar University Hospital, Barcelona, Spain
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11
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Hysteroscopic resection for management of early pregnancy loss: a case report and literature review. F S Rep 2022; 3:163-167. [PMID: 35789723 PMCID: PMC9250123 DOI: 10.1016/j.xfre.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To report a case of early pregnancy loss successfully managed by hysteroscopic resection, review the literature comparing hysteroscopic resection to dilation and curettage for retained products of conception, and review potential advantages of hysteroscopic resection over dilation and curettage for management of early pregnancy loss. Design Case report. Setting Private practice. Patient(s) One woman with early pregnancy loss. Intervention(s) Hysteroscopic resection using a mechanical morcellation device. Main Outcome Measure(s) Complete uterine evacuation after hysteroscopic resection as demonstrated by a normal transvaginal ultrasound and cessation of bleeding 2 weeks after surgery. Result(s) The hysteroscopic fluid deficit was 365 ml, with minimal blood loss. Products of conception were confirmed on pathologic examination. There were no intraoperative or postoperative complications. A saline infusion sonogram obtained 4 months after surgery demonstrated a normal endometrial cavity with no intrauterine adhesions. Conclusion(s) Surgical management of early pregnancy loss may be complicated by retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Hysteroscopic resection of RPOC has been associated with fewer cases of intrauterine adhesions, more cases of complete tissue removal, and earlier time to conception compared with dilation and curettage. Early pregnancy loss can also be characterized as RPOC with potentially similar benefits from hysteroscopic resection. Thus, hysteroscopic resection can be considered as an alternative surgical technique for management of early pregnancy loss. This case report demonstrates the successful application of hysteroscopic resection in a case of early pregnancy loss.
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12
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Meshaal H, Salah E, Fawzy E, Abdel-Rasheed M, Maged A, Saad H. Hysteroscopic management versus ultrasound-guided evacuation for women with first-trimester pregnancy loss, a randomised controlled trial. BMC Womens Health 2022; 22:190. [PMID: 35614405 PMCID: PMC9131545 DOI: 10.1186/s12905-022-01774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the hysteroscopic management of first-trimester pregnancy loss compared to surgical evacuation either blind or under ultrasonographic guidance. METHODS This clinical trial included 315 women with first-trimester pregnancy loss, divided equally into three groups. Group 1 underwent traditional blind surgical evacuation, group 2 underwent ultrasound-guided evacuation, and group 3 underwent hysteroscopic management. All women were assessed for retained products, surgical complications, the need for further management, and pregnancy occurrence after evacuation within 2 years of follow up. RESULTS The rate of presence of conception remnants and the need for further treatment was significantly higher in group 1 compared to groups 2 and 3 (4.8% vs. 0% vs. 0%, P = 0.012). The conception rate within 2 years was significantly lower in group 1 compared to groups 2 and 3 (57.4% vs. 73.2% vs. 82.7%, P = 0.002), and the duration needed to conceive was significantly prolonged in group 1 compared to groups 2 and 3 (9.8 vs. 8.3 vs. 6.9 months, P < 0.001). Interestingly, women who underwent hysteroscopic management needed a significantly shorter time to conceive than those who underwent ultrasound-guided evacuation (6.9 vs. 8.3 months, P = 0.006). CONCLUSIONS Hysteroscopic management of first-trimester pregnancy loss was superior to ultrasound-guided surgical evacuation regarding the time interval to conceive. Both techniques were superior to the blind evacuation technique regarding removal of the whole conception remnants, need for further treatment and fertility outcomes. Clinical trial registration: It was first registered at ClinicalTrials.gov on 16/03/2017 with registration number NCT03081104.
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Affiliation(s)
- Hadeer Meshaal
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Fawzy
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mazen Abdel-Rasheed
- Reproductive Health Research Department, National Research Centre, 33 El-Buhouth St, Dokki, Cairo, 12622, Egypt.
| | - Ahmed Maged
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Saad
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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13
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Office Operative Hysteroscopy for the Management of Retained Products of Conception. Reprod Sci 2022; 29:761-767. [PMID: 35020188 DOI: 10.1007/s43032-022-00849-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
The aim of this study was to compare office to conventional operative hysteroscopy for the treatment of retained products of conception (RPOC). This retrospective cohort study included all women who underwent hysteroscopy due to RPOC between January 2018 and December 2019, in a single tertiary medical care center. Exclusion criteria for hysteroscopy included the following: (1) proximity to delivery (up to 3 weeks); (2) hemodynamic instability; (3) active massive bleeding; and (4) genital tract infection. See-and-treat hysteroscopy (study group) outcomes were compared to operative hysteroscopy (controls). Data were collected from women's medical records. Primary outcome was defined as successful removal of all suspected RPOC with no need for additional intervention. Data are presented as median and interquartile range. During the study period, 222 women underwent hysteroscopy due to RPOC. Of them, 138 (62%) and 84 (38%) underwent see-and-treat and operative hysteroscopy, respectively. Symptomatic women were more commonly referred to operative hysteroscopy (60 (71%) vs. 54 (39%); p = 0.001). Maximal diameter of the suspected finding was smaller both by ultrasound examination (13 (10-18) vs. 18 (13-32) mm; p = 0.001) and by surgeon estimation during diagnostic hysteroscopy (12 (8-20) vs. 20 (14-30) mm; p = 0.001), in the see-and-treat compared to the operative hysteroscopy group, respectively. While comparing success rate between groups, no difference was observed. Sub-analysis by the maximal diameter of RPOC findings revealed that see-and-treat success rate is reduced as the RPOC is larger. Success rate was high and comparable to operative hysteroscopy for findings ≤ 2 cm (102/117 (87%) vs. 49/54 (91%); p = 0.79). Nevertheless, for RPOC > 2 cm, success was significantly more frequent in the operative hysteroscopy group (28/30 (93%) vs. 9/16 (57%); p = 0.002). This finding was supported by logistic regression analysis that found maximal diameter of RPOC as the only parameter associated with success rate (B = 0.96; p = 0.03). Office operative hysteroscopy is a feasible treatment option for the removal of RPOC when maximal diameter is taken under consideration due to its association to success rate.Clinical trial registration: The study protocol was approved by the "Sheba Medical Center" Review Board (ID 5200-18 SMC) on June 24, 2018.
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14
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Foreste V, Gallo A, Manzi A, Riccardi C, Carugno J, Sardo ADS. Hysteroscopy and Retained Products of Conception: An Update. Gynecol Minim Invasive Ther 2021; 10:203-209. [PMID: 34909376 PMCID: PMC8613498 DOI: 10.4103/gmit.gmit_125_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/11/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently associated with continuous vaginal bleeding, pelvic pain, and infection. Late complications include intrauterine adhesions formation and infertility. Conventionally, the management of RPOC has been with blind dilation and suction curettage (D and C); however, hysteroscopic resection of RPOC is a safe and efficient alternative. In this review, we analyze the current available evidence regarding the use of hysteroscopic surgery for the treatment of RPOC comparing outcomes and complications of both traditional curettage and hysteroscopic technique. Data search has been conducted using the following databases MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. Gov., OVID, and Cochrane Library interrogate all articles related to hysteroscopy and the preserved product of conception, updated through September 2020.
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Affiliation(s)
- Virginia Foreste
- Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alessandra Gallo
- Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alfonso Manzi
- Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carla Riccardi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Jose Carugno
- Department of Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
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15
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Taylor C, Ellett L, Hiscock R, Mooney S. Hysteroscopic management of retained products of conception: A systematic review. Aust N Z J Obstet Gynaecol 2021; 62:22-32. [PMID: 34751942 DOI: 10.1111/ajo.13455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The management of retained products of conception (RPOC) is not well standardised due to a lack of evidence-based guidelines. Hysteroscopic resection has been proven to be safe and is hypothesised to have lower risk than dilation and curettage, but data comparing the two directly are limited. AIM The aim of this study is to evaluate the outcomes for hysteroscopic resection for the management of RPOC in comparison to current standard management techniques. METHODS A literature search was conducted in September 2019 using MEDLINE, Scopus, The Cochrane Library and Web of Science. The key search terms were 'hysteroscopy'/'hysteroscopic resection' and 'retained products of conception'/'RPOC'. Both prospective and retrospective studies were included. A total of 19 studies were included (n = 2314). Due to a critical risk of bias in all studies with a comparison arm, a meta-analysis was not performed. Meta-analysis techniques were still used to provide summary estimates for primary and secondary outcomes, including conception rate, time to conception, live birth rate, intrauterine adhesions (IUAs), surgical complications and future pregnancy complications. RESULTS The overall conception rate for hysteroscopic resection was 81.1% (live birth rate 87.3%) compared to 65.4% for non-hysteroscopic management (live birth rate 93.8%). After hysteroscopic resection the overall complication rate was 1.9% and the IUA rate was 6.8%. CONCLUSIONS Due to the poor quality and overall scarcity of comparative data, the question whether hysteroscopic resection is superior to traditional curettage for the management of RPOC remains unanswered. This review provides summary data, which will enable the design of adequately powered future studies.
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Affiliation(s)
- Cassandra Taylor
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Western Health, Melbourne, Victoria, Australia
| | - Lenore Ellett
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Richard Hiscock
- Mercy Perinatal at Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Samantha Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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16
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Chill HH, Safrai M, Karavani G, Cohen A, Alexandroni H, Bahar R, Shushan A. Reproductive and obstetric outcomes following operative hysteroscopy for treatment of retained products of conception. Minerva Obstet Gynecol 2021; 73:494-499. [PMID: 34319060 DOI: 10.23736/s2724-606x.21.04761-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retained products of conception following delivery or early pregnancy failure are often treated by operative hysteroscopy. We aimed to evaluate reproductive and obstetric outcomes following operative hysteroscopy for treatment of retained products of conception. We also investigated the effect of time interval between operative hysteroscopy and pregnancy on these outcomes. METHODS A retrospective cohort study conducted at the gynecology department of a tertiary teaching hospital between January 2012 and December 2016. Included were women who underwent operative hysteroscopy for treatment of retained products of conception and became pregnant following the procedure. Reproductive and obstetric data were retrieved from electronic medical records and by telephone questionnaire. The effect of time interval between operative hysteroscopy and pregnancy on reproductive outcomes was also evaluated by comparing women who conceived 6 months or less and women who conceived more than 6 months following surgery. RESULTS Seventy-nine women who underwent operative hysteroscopy for treatment of retained products of conception and who conceived later were included. Mean time from women's attempt to conceive to conception was 4.6 (SD=6.4) months. Conception rate was 84.8% at 6 months and reached 92.4% at 12 months postsurgery. Miscarriage rate for the consecutive pregnancy following hysteroscopy was 15.2% and delivery rate was 84.8%. Two cases of obstetric complications including one case of retained placenta and one case of post-partum hemorrhage were noted. Time interval between operative hysteroscopy and pregnancy did not affect reproductive or obstetric outcomes. CONCLUSIONS Women treated by operative hysteroscopy for retained products of conception have no negative reproductive and obstetric outcomes. Time interval between the procedure and pregnancy has no effect on these outcomes.
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Affiliation(s)
- Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Myriam Safrai
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Heli Alexandroni
- Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center and Hebrew University Medical School, Jerusalem, Israel
| | - Raz Bahar
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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17
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Vitale SG, Parry JP, Carugno J, Cholkeri-Singh A, Della Corte L, Cianci S, Schiattarella A, Riemma G, De Franciscis P. Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:204-217. [PMID: 33166659 DOI: 10.1016/j.jmig.2020.10.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of hysteroscopy for retained products of conception (RPOC) removal on surgical and reproductive outcomes. DATA SOURCES Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, SciELO, EMBASE, and the Cochrane Central Register of Controlled Trials at the Cochrane Library) were searched from inception to March 2020. METHODS OF STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Medical Subject Headings terms and text words such as "retained products of conception," "placental remnants," "placenta," and "hysteroscopy" were used for the identification of relevant studies. We included observational and randomized studies that analyzed surgical and/or reproductive outcomes of women who underwent hysteroscopic removal of RPOC. The primary outcome was the complete resection rate after 1 procedure. TABULATION, INTEGRATION, AND RESULTS Twenty out of 245 studies were applicable, with data provided for 2112 women. The pooled complete resection rate was 91% (95% confidence interval [CI], 0.83-0.96). The incomplete resection rate evaluated was 7% (95% CI, 0.03-0.14), with a complication rate of 2% (95% CI, 0.00-0.04). Out of 1478 procedures, only 12 cases (0.8%) of postsurgical intrauterine adhesions were reported. Regarding post-therapy fecundity, women attempting postoperative conception had a clinical pregnancy rate of 87% (95% CI, 0.75-0.95), with a live birth rate of 71% (95% CI, 0.60-0.81) and a pregnancy loss rate of 9% (95% CI, 0.06-0.12). CONCLUSION Hysteroscopy has a high rate of completely removing RPOC in a single surgical step, with low complication rates. Subsequent fecundity seems reassuring, with appropriate clinical pregnancy and live birth rates. However, standardization of approach and comparative trials of different hysteroscopic approaches are needed.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania (Dr. Vitale), Catania, Italy.
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, Mississippi; Department of Obstetrics and Gynecology, University of Mississippi Medical Center (Dr. John Preston Parry), Jackson, Mississippi
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami (Dr. Jose Carugno's), Miami, FL, USA
| | - Aarathi Cholkeri-Singh
- Department of Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA (Dr. Aarathi Cholkeri-Singh's)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II (Dr. Luigi Della Corte's), Naples, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
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18
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Li C, Cong L, Wang W. Two cases of larger cornual residual villi, treated by the hysteroscopic cold knife. J Obstet Gynaecol Res 2020; 46:2430-2434. [PMID: 32935400 DOI: 10.1111/jog.14416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
The present report describes two cases of larger cornual residual villi after dilatation and curettage because of missed abortion, treated by the hysteroscopic cold knife. One case is 39 years old and the other is 30 years old, both cases were treated with dilatation and curettage because of missed abortion, surprisingly, one of the patients suffered two curettage surgeries. After the curettage, with irregular vaginal bleeding more than 3 months, pelvic ultrasonography revealed an enlarged uterine cavity with a lager cornual residual villi was suspected. We treated them with Hysteroscopy Endo-Operative System, the operation was successful without any complications. The blood β-HCG drops rapidly to normal after surgery. We performed office hysteroscopy for them 1 month after the operation, and the corners of uterine were normal. The hysteroscopic cold knife may represent a valid tool for the treatment of large cornual residual villi.
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Affiliation(s)
- Congqing Li
- Department of Obstetrics and Gynecology, The Second Hospital of Anhui Medical University, Hefei, China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lin Cong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Anhui Medical University, Hefei, China
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de Codt M, Balza C, Jadoul P, Forget P, Squifflet JL, Bernard P, Luyckx M. Hysteroscopic Resection for Missed Abortion: Feasibility, Operative Technique and Potential Benefit Compared to Curettage. Front Surg 2020; 7:64. [PMID: 33102514 PMCID: PMC7505996 DOI: 10.3389/fsurg.2020.00064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the feasibility of hysteroscopic resection (HsR) for primary surgical management of missed abortion. Reproductive outcomes and potential benefit of this technique will be compared to traditional dilatation and curettage (D&C). Design: Retrospective cohort study in two Departments (Gynecology and Obstetrics) of a tertiary medical care center (Canadian Task Force classification II-2). Patients: Women with first trimester missed abortion. Intervention: Two techniques were used for the management of missed abortion: ultrasound-guided dilatation and curettage (D&C) and hysteroscopic resection (HsR). Results: We evaluated 358 patients who underwent primary surgical removal of missed abortion. Hundred seventy three patients have been treated by D&C and 185 underwent HsR. In the HsR group, 110 patients (59.5%) have obtained their pregnancy with in vitro fertilization (IVF) vs. 7 patients (4.0%) in the D&C group which make the HsR population hypofertile in comparison to the D&C population. The intra- and post-operative complication rates are low and comparable. Intrauterine anomalies were diagnosed during the HsR in 10 patients (5.4%) and could be investigated after the intervention as a possible cause of miscarriage. Because of the difference in term of fertility, the reproductive outcomes have been analyzed by multivariate analysis. The hazard ratio of pregnancy at 6 months, adjusted to the factor IVF for D&C compared to HsR is 0.69 [0.49–0.96] (p = 0.026). That could represent a significant benefit in the particular population followed in IVF, but regarding the retrospective analysis, and the very different population in the two groups, it doesn't allow us to draw any evidence based conclusion. Conclusion: Hysteroscopic resection is a feasible and safe procedure for the management of missed abortion that could increase the diagnosis of uterine abnormalities. With all the limitation of the design of our study, our data seems to show a trend to a potential benefit in term of reproductive outcomes for hypofertile patient undergoing IVF treatment.
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Affiliation(s)
- Matthieu de Codt
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Claire Balza
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pascale Jadoul
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Patrice Forget
- Clinical Chair in Anaesthesia, University of Aberdeen, Honorary Consultant, NHS Grampian, Aberdeen, United Kingdom
| | - Jean-Luc Squifflet
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Bernard
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mathieu Luyckx
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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van Wessel S, Coryn N, van Vliet H, Schoot B, Weyers S, Hamerlynck T. Reproductive and Obstetric Outcomes After Hysteroscopic Removal of Retained Products of Conception. J Minim Invasive Gynecol 2020; 27:840-846. [DOI: 10.1016/j.jmig.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022]
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21
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Santamaria X, Isaacson K, Simón C. Asherman's Syndrome: it may not be all our fault. Hum Reprod 2020; 33:1374-1380. [PMID: 31986212 DOI: 10.1093/humrep/dey232] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 01/24/2023] Open
Abstract
Asherman's Syndrome (AS) is an acquired condition defined by the presence of intrauterine adhesions (IUA) that cause symptoms such as menstrual abnormalities, pelvic pain, infertility, recurrent miscarriage, abnormal placentation and attendant psychological distress. Classically, AS is considered an iatrogenic disease triggered by trauma to the pregnant uterus. Different factors can cause the destruction of the endometrium, thus affecting the endometrial stem cell niche and creating IUAs. Curettage of the pregnant uterus appears to be the most common source of this destruction. Nevertheless, some AS cases have been associated with congenital uterine abnormalities and infections, and there are some idiopathic cases without any prior surgical procedures, suggesting a putative constitutional predisposition to IUA. Factors reported to cause AS share an underlying inflammatory mechanism leading to defective endometrial healing and vascularization. Interestingly, distinct genetic profiles have been observed in the endometrium of AS patients. These data suggest that AS might not just be an iatrogenic complication, but also the result of a genetic predisposition. Elucidating the possible physiopathological processes that contribute to AS will help to identify patients at risk for this condition, providing an opportunity for prevention.
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Affiliation(s)
| | - Keith Isaacson
- Department of Obstetrics and Gynecology and Reproductive Endocrinology, Harvard Medical School, Boston, MA, USA
| | - Carlos Simón
- Igenomix Academy, Valencia, Spain
- Department of Obstetrics and Gynecology. Stanford University, Stanford, CA, USA
- Department of Obstetrics and Gynecology. Baylor College of Medicine, Houston, TX, USA
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Jakopič Maček K, Blaganje M, Kenda Šuster N, Drusany Starič K, Kobal B. Office hysteroscopy in removing retained products of conception – a highly successful approach with minimal complications. J OBSTET GYNAECOL 2019; 40:1122-1126. [DOI: 10.1080/01443615.2019.1679736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Katja Jakopič Maček
- Division of gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mija Blaganje
- Division of gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Kenda Šuster
- Division of gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Borut Kobal
- Division of gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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23
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Garofalo A, Desgro M. WITHDRAWN: Hysteroscopic removal of placental remnants using the Bigatti Shaver®: A mininvasive surgical approach. Eur J Obstet Gynecol Reprod Biol 2019:S0301-2115(19)30420-8. [PMID: 31551168 DOI: 10.1016/j.ejogrb.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Anna Garofalo
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy.
| | - Marcello Desgro
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy
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Can S, Kirpinar G, Dural O, Karamustafaoglu BB, Tas IS, Yasa C, Ugurlucan FG. Efficacy of a New Crosslinked Hyaluronan Gel in the Prevention of Intrauterine Adhesions. JSLS 2019; 22:JSLS.2018.00036. [PMID: 30524185 PMCID: PMC6261745 DOI: 10.4293/jsls.2018.00036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: The authors sought to assess the effect of the use of a new crosslinked hyaluronan (NCH) gel on the prevention of intrauterine adhesions (IUAs) in women underwent curettage in the second trimester. Methods: Between June 2016 and September 2017, 60 patients who underwent curettage for retained placental tissue after medically induced or spontaneous pregnancy loss in the second trimester were enrolled in the study. The patients were randomly assigned to 1 of 2 groups: Group 1 patients received curettage plus NCH gel (intervention group), and group 2 patients received curettage alone (control group). The main outcomes were the rate and severity of IUA formation, which were assessed by follow-up hysteroscopy performed in the ensuing 2–6 months. Results: The hysteroscopic findings were available for 20 patients in group 1 and 28 patients in group 2. IUAs were observed in 6 patients in group 2, while no IUAs was observed in group 1 (P = .007). IUAs were staged as mild in 4 patients (14.28%) and moderate in 2 patients (7.14%) in group 2 according to the American Fertility Society classification of IUAs. Conclusions: Our study demonstrates that NCH gel appears to be able to reduce the formation of IUAs in women who undergo curettage in the second trimester, although larger controlled, randomized, multicenter studies are needed to confirm these results.
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Affiliation(s)
- Sultan Can
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Gamze Kirpinar
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ozlem Dural
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | | | - Inci Sema Tas
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cenk Yasa
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- School of Medicine, Istanbul University, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Pons Jimenez L, Rovira Pampalona J, Guerra García Á, Martinez Canela J, Oliveres Amor C, Mateu Pruñonosa J, Degollada Bastos M, Brescó Torras P. Manejo histeroscópico de los restos ovulares con energía mecánica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Capmas P, Lobersztajn A, Duminil L, Barral T, Pourcelot AG, Fernandez H. Operative hysteroscopy for retained products of conception: Efficacy and subsequent fertility. J Gynecol Obstet Hum Reprod 2018; 48:151-154. [PMID: 30553048 DOI: 10.1016/j.jogoh.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022]
Abstract
Retained product of conception complicates nearly 1% of pregnancies and can lead to synechiae and compromise ulterior fertility. The aim of this study is to evaluate efficiency of operative hysteroscopy in management of retained products of conception (RPOC). Secondary objectives are assessments of intra-uterine adhesions rate and later fertility. This unicentric retrospective study includes women who undertook an operative hysteroscopy for retained products of conception between January 2012 and March 2014. Assessment of the efficiency of operative hysteroscopy is defined by a complete resection of retained products of conception confirmed by office hysteroscopy. One hundred fourteen women were included in the study. Efficiency of operative hysteroscopy for retained products of conception is 91% for women with a postoperative office hysteroscopy. The authors observed a 7.5% rate of postoperative intra-uterine adhesions. Fertility rate was 83% (30 women out of 36 with a desired pregnancy). Hysteroscopic resection of retained products of conception is an efficient procedure and seems to be a real alternative.
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Affiliation(s)
- Perrine Capmas
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France; INSERM, U1018, Centre of research in Epidemiology and population health (CESP), F-94276, Le Kremlin Bicêtre, France.
| | - Anina Lobersztajn
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France
| | - Laura Duminil
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France
| | - Tiphaine Barral
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France
| | - Anne-Gaëlle Pourcelot
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France; Faculty of medicine, University Paris Saclay, F-94276, Le Kremlin Bicêtre, France
| | - Hervé Fernandez
- AP-HP, Department of Gynecology and Obstetrics, Hospital Bicêtre, GHU Sud, F-94276, Le Kremlin Bicêtre, France; INSERM, U1018, Centre of research in Epidemiology and population health (CESP), F-94276, Le Kremlin Bicêtre, France; Faculty of medicine, University Paris Saclay, F-94276, Le Kremlin Bicêtre, France
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27
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van Wessel S, Hamerlynck T, Schoot B, Weyers S. Hysteroscopy in the Netherlands and Flanders: A survey amongst practicing gynaecologists. Eur J Obstet Gynecol Reprod Biol 2018; 223:85-92. [PMID: 29510373 DOI: 10.1016/j.ejogrb.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/05/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To gain insight in the current ideas on, and implementation of hysteroscopy amongst practicing gynaecologists in the Netherlands and Flanders. STUDY DESIGN In August 2016 an electronic questionnaire was sent to practising gynaecologist members of the Dutch (N = 591) and Flemish (N = 586) Society of Obstetrics and Gynaecology. RESULTS The response rate for the Netherlands was 15.4% (91/591), and for Flanders 27.0% (158/586). Responding gynaecologists have a preference for hysteroscopy for diagnosing and treating most intrauterine pathology. Flemish respondents are more hesitant in opting for hysteroscopy instead of curettage for treatment of polyps and placental remnants. There appears to be a wide diffusion of diagnostic and basic operative hysteroscopy. In contrast to Flanders, responding hysteroscopists from the Netherlands more often perform office hysteroscopic procedures. Hysteroscopic procedures, and office procedures in particular, are now educated during residency. Therefore, recently graduated gynaecologists have a preference for this technique. CONCLUSION Our survey confirms that nowadays the focus of treating intrauterine pathology is on less invasive techniques and preserving the uterus. Dutch responding hysteroscopists have more expertise concerning office hysteroscopy than their Flemish colleagues. Future research on the cost-effectiveness of and optimisation of patient comfort during office hysteroscopy is needed to support its further implementation.
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Affiliation(s)
- Steffi van Wessel
- Women's Clinic, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Tjalina Hamerlynck
- Women's Clinic, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Benedictus Schoot
- Women's Clinic, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Di Spiezio Sardo A, Di Guardo F, Santangelo F, Cianci S, Giampaolino P. Commentary on "Assessment of Risk Factors of Intrauterine Adhesions in Patients with Induced Abortion and the Curative Effect of Hysteroscopic Surgery". J INVEST SURG 2017; 32:90-92. [PMID: 29252055 DOI: 10.1080/08941939.2017.1400133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Attilio Di Spiezio Sardo
- a Department of Public Health , School of Medicine, University of Naples "Federico II" , Naples , Italy
| | - Federica Di Guardo
- b Department of General Surgery and Medical Surgical Specialties , University of Catania , Catania , Italy
| | - Fabrizia Santangelo
- a Department of Public Health , School of Medicine, University of Naples "Federico II" , Naples , Italy
| | - Stefano Cianci
- c Division of Gynecologic Oncology , Department of Obstetrics and Gynecology , Catholic University of the Sacred Heart , Rome , Italy
| | - Pierluigi Giampaolino
- a Department of Public Health , School of Medicine, University of Naples "Federico II" , Naples , Italy
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29
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Karavani G, Bahar R, Herzberg S, Yanai N. A "See and Treat" Office Procedure for Retained Products of Conception Removal After Normal Vaginal Delivery Using Manual Vacuum Aspiration: Preliminary Efficacy and Reproductive Outcomes. J Minim Invasive Gynecol 2017. [PMID: 28642091 DOI: 10.1016/j.jmig.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To compare the efficacy and reproductive outcomes of an ultrasound-guided manual vacuum aspiration (MVA) procedure with the widely accepted operative hysteroscopic (OH) procedure in the removal of retained products of conception (RPOCs) after normal vaginal delivery. DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING A university-affiliated tertiary medical center. PATIENTS Eighty-six patients after normal vaginal delivery diagnosed with RPOCs from 2005 through 2015. This study was approved by the local institutional review board. INTERVENTIONS Treatment with either MVA or OH for patients diagnosed with RPOCs. MEASUREMENTS AND MAIN RESULTS Of 86 patients, 23 underwent remnant removal by ultrasound-guided MVA using a 6- to 7-mm catheter in a "see and treat" office procedure. Sixty-three patients underwent remnant removal using the OH procedure. Follow-up included sonographic examination 3 to 5 weeks after the procedure and long-term follow-up on complications and reproductive outcomes. Successful remnant evacuation and the overall complications rates were similar when comparing the MVA group and the OH group (95.7% vs 96.8% and 4.3% vs 4.7%, respectively). Conception rates and miscarriage rates were comparable in the MVA and OH groups (78.6% vs 72.2% and 9.1% vs 14.8%, respectively). CONCLUSION Preliminary results from 23 patients suggest that MVA is an efficient procedure with low complication rates and satisfactory reproductive outcomes. It does not require anesthesia or operating room facilities, allowing an immediate and inexpensive "see and treat" option for RPOCs. Further larger controlled trials are required.
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Affiliation(s)
- Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Raz Bahar
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shmuel Herzberg
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nili Yanai
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial. Fertil Steril 2017; 107:1223-1231.e3. [PMID: 28390688 DOI: 10.1016/j.fertnstert.2017.02.113] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/04/2017] [Accepted: 02/26/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine whether intrauterine application of auto-crosslinked hyaluronic acid (ACP) gel, after dilatation and curettage (D&C), reduces the incidence of intrauterine adhesions (IUAs). DESIGN Multicenter; women and assessors blinded prospective randomized trial. SETTING University and university-affiliated teaching hospitals. PATIENT(S) A total of 152 women with a miscarriage of <14 weeks with at least one previous D&C for miscarriage or termination of pregnancy. INTERVENTION(S) Women were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A follow-up diagnostic hysteroscopy was scheduled 8-12 weeks after the D&C procedure. MAIN OUTCOME MEASURE(S) The primary outcome was the number of women with IUAs and the secondary outcome was the severity of IUAs. RESULT(S) Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The IUAs were observed in 10 (13.0%) and 22 women (30.6%), respectively (relative risk, 0.43; 95% confidence interval 0.22-0.83). Mean adhesion score and the amount of moderate-to-severe IUAs were significantly lower in the intervention group according to the American Fertility Society (AFS) and European Society of Gynecological Endoscopy classifications systems of adhesions. CONCLUSION(S) Intrauterine application of ACP gel after D&C for miscarriage in women with at least one previous D&C seems to reduce the incidence and severity of IUAs but does not eliminate the process of adhesion formation completely. Future studies are needed to confirm our findings and to evaluate the effect of ACP gel on fertility and reproductive outcomes. CLINICAL TRIAL REGISTRATION NUMBER NTR 3120.
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Sonnier L, Torre A, Broux P, Fauconnier A, Huchon C. Evaluation of fertility after operative hysteroscopy to remove retained products of conception. Eur J Obstet Gynecol Reprod Biol 2017; 211:98-102. [DOI: 10.1016/j.ejogrb.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 11/17/2022]
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Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment. Cardiovasc Intervent Radiol 2016; 40:520-529. [DOI: 10.1007/s00270-016-1543-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
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33
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Ikhena DE, Bortoletto P, Lawson AK, Confino R, Marsh EE, Milad MP, Steinberg ML, Confino E, Pavone MEG. Reproductive Outcomes After Hysteroscopic Resection of Retained Products of Conception. J Minim Invasive Gynecol 2016; 23:1070-1074. [DOI: 10.1016/j.jmig.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
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Hamerlynck TWO, van Vliet HAAM, Beerens AS, Weyers S, Schoot BC. Hysteroscopic Morcellation Versus Loop Resection for Removal of Placental Remnants: A Randomized Trial. J Minim Invasive Gynecol 2016; 23:1172-1180. [PMID: 27590568 DOI: 10.1016/j.jmig.2016.08.828] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To compare hysteroscopic morcellation with loop resection for the removal of placental remnants in terms of procedure time, adverse events, tissue availability, histology results, short-term effectiveness, and postoperative adhesions. DESIGN A randomized controlled trial (Canadian Task Force classification I). SETTING A teaching and university hospital. PATIENTS Women with placental remnants. INTERVENTIONS Hysteroscopic morcellation with the TRUCLEAR 8.0 Tissue Removal System (Smith & Nephew, Inc, Andover, MA) or loop resection with a rigid 8.5-mm bipolar resectoscope (Karl Storz GmbH, Tuttlingen, Germany). MEASUREMENTS AND MAIN RESULTS Forty-six and 40 women were included in the hysteroscopic morcellation and resection groups, respectively. The median operating time was significantly shorter for hysteroscopic morcellation compared with loop resection (6.2 minutes [interquartile range, 4.0-11.2 minutes] vs 10.0 minutes [5.8-16.4 minutes], p = .023). Both operating time and total procedure time, corrected for the diameter of the placental remnants, were significantly reduced for hysteroscopic morcellation compared with loop resection, by 40% (95% confidence interval, 15%-58%; p = .005) and 22% (95% CI, 5%-37%; p = .014), respectively. No adverse events occurred during hysteroscopic removal. Perforation at dilation in 8 cases of the hysteroscopic morcellation group resulted in 2 procedure discontinuations and 1 incomplete procedure. Incomplete removal was found in 1 uncomplicated hysteroscopic morcellation procedure and 2 resection procedures. Pathology results confirmed the presence of placental remnants in 27 of 40 (67.5%) and 26 of 37 (70%) patients in the hysteroscopic morcellation and resection groups, respectively. Second-look hysteroscopy showed de novo intrauterine adhesions in 1 of 35 patients (3%) in the hysteroscopic morcellation group and 1 of 30 (3%) patients in the resection group. CONCLUSION Hysteroscopic morcellation is a faster alternative than loop resection. Both techniques are safe and show high rates of complete removal and tissue availability and low rates of de novo intrauterine adhesions.
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Affiliation(s)
| | - Huib A A M van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Benedictus C Schoot
- Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
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Omakwu O, Uppal T, Infante Torres F. The role of ultrasonography in the management of post-partum haemorrhage associated with retained products of conception: A case report. Australas J Ultrasound Med 2016; 19:78-83. [DOI: 10.1002/ajum.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Oine Omakwu
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Talat Uppal
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Fernando Infante Torres
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
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Chua AAA, Huang KG, Wu KY. The application of hysteroscopy in gestational trophoblastic disease. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Promberger R, Ott J, Chalubinski KM. Ten-Year Experience with the Conservative Management of Abnormally Invasive, Residual Trophoblastic Disease. A Retrospective Case Series. Gynecol Obstet Invest 2016; 81:375-80. [PMID: 26824748 DOI: 10.1159/000443395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
Conservative management of abnormally invasive, residual trophoblastic disease (AIRTD) is underreported. We aimed at critically reviewing our experience with such conservative management. We conducted a retrospective cohort study that included 24 women. The median completed week of gestation at delivery (20/24, 83.3%)/2nd trimester miscarriage (4/24, 16.7%) was 35 (range 17-41). Two women initially chose a surgical treatment (dilatation and curettage), but AIRTD remained sonographically visible afterward. Five patients developed a fever >38.0°C for ≥2 days (5/24, 20.8%). Due to heavy vaginal bleeding, 2 patients then underwent dilatation, diagnostic hysteroscopy, and curettage (2/24, 8.3%). One of these women also had to undergo hysterectomy (1/24, 4.2%). The 23 patients without hysterectomy underwent regular sonographic follow-up examinations. Regression of AIRTD was found after a median of 74 days (range 36-323). In conclusion, our data suggest that a conservative, observational treatment is feasible in AIRTD, with low rates of secondary surgical interventions. The long time intervals until regression require perseverance by these patients.
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Affiliation(s)
- Regina Promberger
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria
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Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review. Fertil Steril 2016; 105:156-64.e1-2. [DOI: 10.1016/j.fertnstert.2015.09.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
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Huchon C, Koskas M, Agostini A, Akladios C, Alouini S, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Matheron I, Panel P, Raiffort C, Fauconnier A. Operative hysteroscopy versus vacuum aspiration for incomplete spontaneous abortion (HY-PER): study protocol for a randomized controlled trial. Trials 2015; 16:363. [PMID: 26282937 PMCID: PMC4539935 DOI: 10.1186/s13063-015-0900-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/03/2015] [Indexed: 12/25/2022] Open
Abstract
Background Incomplete spontaneous abortions are defined by the intrauterine retention of the products of conception after their incomplete or partial expulsion. This condition may be managed by expectant care, medical treatment or surgery. Vacuum aspiration is currently the standard surgical treatment in most centers. However, operative hysteroscopy has the advantage over vacuum aspiration of allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications. Inadequately powered retrospective studies reported subsequent fertility to be higher in patients treated by operative hysteroscopy than in those treated by vacuum aspiration. These data require confirmation in a randomized controlled trial comparing fertility rates between women undergoing hysteroscopy and those undergoing vacuum aspiration for incomplete spontaneous abortion. Methods After providing written informed consent, 572 women with incomplete spontaneous abortion recruited from 15 centers across France will undergo randomization by a centralized computer system for treatment by either vacuum aspiration or operative hysteroscopy. Patients will not be informed of the type of treatment that they receive and will be cared for during their hospital stay in accordance with standard practices at each center. The patients will be monitored for pregnancy or adverse effects by a telephone conversation or questionnaire sent by e-mail or post over a period of two years. In cases of complications, failure of the intervention or diagnosis of uterine cavity disease, patient care will be left to the discretion of the medical center team. Discussion If our hypothesis is confirmed, this study will provide evidence that the use of operative hysteroscopy can increase the number of pregnancies continuing beyond 22 weeks of gestation in the two-year period following incomplete spontaneous abortion without increasing the incidence of morbidity and peri- and postoperative complications. The standard surgical treatment of this condition would thus be modified. This study would therefore have a large effect on the surgical management of incomplete spontaneous abortion. Trial registration ClinicalTrials.gov Identifier: NCT02201732; registered on 17 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0900-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obcstetrics, CHI Poissy-St-Germain, 10 Rue du champ Gaillard, BP 3082, CEDEX 78303, Poissy, France. .,Equipe d'accueil EA 7285 Risques, Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale, Université Versailles-Saint-Quentin en Yvelines, 78180, Montigny le Bretonneux, France.
| | - Martin Koskas
- Equipe d'accueil EA 7285 Risques, Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale, Université Versailles-Saint-Quentin en Yvelines, 78180, Montigny le Bretonneux, France. .,Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris Diderot University, Paris, France.
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, 147, Boulevard Baille, Cedex 5 13385, Marseille, France.
| | - Cherif Akladios
- Department of Gynecology and Obstetrics, Strasbourg University Hospital, 1 Avenue Molière, 67000, Strasbourg, France.
| | - Souhail Alouini
- Department of Gynecologic Surgery and Obstetrics, CHR Orleans, 1 Porte Madeleine, 45000, Orléans, France.
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, 16 Rue de Bulgarie, B.P. 90347, Cedex 2, F-35203, Rennes, France.
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Cedex 1, Clermont Ferrand, France. .,Faculté de Medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000, Clermont-Ferrand, France.
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, 78 Rue du Général Leclerc, Le Kremlin Bicêtre, 94270, France. .,CESP-INSERM U1018, 82 Rue du Général Leclerc, Le Kremlin Bicêtre, 94276, France. .,Université Paris Sud, 63 Rue Gabriel Péri, Le Kremlin Bicêtre, 94270, France.
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, 2 Rue de la Milétrie, F-86000, Poitiers, France.
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, 45 Rue Cognacq-Jay, 51092, Reims, France.
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d'Angers, 4, Rue Larrey, 49033 Cedex 01, AngersPays De La Loire, France.
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, 59037, Lille, France.
| | - Isabelle Matheron
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal, Villeneuve-Saint-Georges, Paris, France.
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, 177, Rue de Versailles, 78157, Le Chesnay, France.
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, France Université Paris-Diderot, Paris, France.
| | - Arnaud Fauconnier
- Equipe d'accueil EA 7285 Risques, Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale, Université Versailles-Saint-Quentin en Yvelines, 78180, Montigny le Bretonneux, France. .,Department of Gynecology and Obcstetrics, CHI Poissy-St-Germain, 10 Rue du champ Gaillard, BP 3082, 78300, Poissy, France.
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40
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Hysteroscopy for Infertile Women: A Review. J Minim Invasive Gynecol 2015; 22:353-62. [DOI: 10.1016/j.jmig.2014.12.163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/17/2022]
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Akladios C, Sananes N, Gaudineau A, Boudier E, Langer B. Hémorragie secondaire du post-partum. ACTA ACUST UNITED AC 2014; 43:1161-9. [DOI: 10.1016/j.jgyn.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Beucher G, Dolley P, Stewart Z, Lavoué V, Deffieux X, Dreyfus M. Obtention de la vacuité utérine dans le cadre d’une perte de grossesse. ACTA ACUST UNITED AC 2014; 43:794-811. [DOI: 10.1016/j.jgyn.2014.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hooker AB, Muller LT, Paternotte E, Thurkow AL. Immediate and long-term complications of delayed surgical management in the postpartum period: a retrospective analysis. J Matern Fetal Neonatal Med 2014; 28:1884-9. [DOI: 10.3109/14767058.2014.972356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beucher G, Dolley P, Stewart Z, Carles G, Dreyfus M. Fausses couches du premier trimestre : bénéfices et risques des alternatives thérapeutiques. ACTA ACUST UNITED AC 2014; 42:608-21. [DOI: 10.1016/j.gyobfe.2014.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
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45
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Ben-Ami I, Melcer Y, Smorgick N, Schneider D, Pansky M, Halperin R. A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception. Int J Gynaecol Obstet 2014; 127:86-9. [DOI: 10.1016/j.ijgo.2014.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/29/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
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Pérez-Medina T, Sancho-Saúco J, Ríos M, Pereira A, Argila N, Cabezas E, Cayuela E. Hysteroscopy in Pregnancy-Related Conditions: Descriptive Analysis in 273 Patients. J Minim Invasive Gynecol 2014; 21:417-25. [DOI: 10.1016/j.jmig.2013.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/30/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
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Smorgick N, Barel O, Fuchs N, Ben-Ami I, Pansky M, Vaknin Z. Hysteroscopic management of retained products of conception: meta-analysis and literature review. Eur J Obstet Gynecol Reprod Biol 2014; 173:19-22. [DOI: 10.1016/j.ejogrb.2013.11.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/01/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
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Tam T, Estes SJ. Hysteroscopic Morcellator Used in the Diagnosis and Evacuation of Retained Products of Conception. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Tam
- Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Stephanie J. Estes
- Division of Reproductive Endocrinology and Infertility, all in Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Hamerlynck TW, Blikkendaal MD, Schoot BC, Hanstede MM, Jansen FW. An Alternative Approach for Removal of Placental Remnants: Hysteroscopic Morcellation. J Minim Invasive Gynecol 2013; 20:796-802. [DOI: 10.1016/j.jmig.2013.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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50
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Hooker AB, Lemmers M, Thurkow AL, Heymans MW, Opmeer BC, Brölmann HAM, Mol BW, Huirne JAF. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome. Hum Reprod Update 2013; 20:262-78. [PMID: 24082042 DOI: 10.1093/humupd/dmt045] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Approximately 15-20% of all clinically confirmed pregnancies end in a miscarriage. Intrauterine adhesions (IUAs) are a possible complication after miscarriage, but their prevalence and the contribution of possible risk factors have not been elucidated yet. In addition, the long-term reproductive outcome in relation to IUAs has to be elucidated. METHODS We systematically searched the literature for studies that prospectively assessed the prevalence and extent of IUAs in women who suffered a miscarriage. To be included, women diagnosed with a current miscarriage had to be systematically evaluated within 12 months by hysteroscopy after either spontaneous expulsion or medical or surgical treatment. Studies that included women with a history of recurrent miscarriage only or that evaluated the IUAs after elective abortion or beyond 12 months after the last miscarriage were not included. Subsequently, long-term reproductive outcomes after expectant (conservative), medical or surgical management were assessed in women with and without post-miscarriage IUAs. RESULTS We included 10 prospective studies reporting on 912 women with hysteroscopic evaluation within 12 months of miscarriage and 8 prospective studies, including 1770 women, reporting long-term reproductive outcome. IUAs were detected in 183 women, resulting in a pooled prevalence of 19.1% [95% confidence interval (CI): 12.8-27.5%]. The extent of IUAs was reported in 124 women (67.8%) and was mild, moderate and severe respectively in 58.1, 28.2 and 13.7% of cases. Relative to women with one miscarriage, women with two or three or more miscarriages showed an increased risk of IUAs by a pooled OR of 1.41 and 2.1, respectively. The number of dilatation and curettage (D&C) procedures seemed to be the main driver behind these associations. A total of 150 congenital and acquired intrauterine abnormalities were encountered in 675 women, resulting in a pooled prevalence of 22.4% (95% CI: 16.3-29.9%). Similar reproductive outcomes were reported subsequent to conservative, medical or surgical management for miscarriage, although the numbers of studies and of included women were limited. No studies reported long-term reproductive outcomes following post-miscarriage IUAs. CONCLUSIONS IUAs are frequently encountered, in one in five women after miscarriage. In more than half of these, the severity and extent of the adhesions was mild, with unknown clinical relevance. Recurrent miscarriages and D&C procedures were identified as risk factors for adhesion formation. Congenital and acquired intrauterine abnormalities such as polyps or fibroids were frequently identified. There were no studies reporting on the link between IUAs and long-term reproductive outcome after miscarriage, while similar pregnancy outcomes were reported subsequent to conservative, medical or surgical management. Although this review does not allow strong clinical conclusions on treatment management, it signals an important clinical problem. Treatment strategies are proposed to minimize the number of D&C in an attempt to reduce IUAs.
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Affiliation(s)
- Angelo B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medical Center, Zaandam, The Netherlands
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