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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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Hu KL, Zhao J, Lin M, Wang X, Qi L, Liu H, Mo D, Zeng Z, Mol BW, Li R. Addition of operative hysteroscopy to vacuum aspiration for the management of early pregnancy loss after in vitro fertilization. Fertil Steril 2024:S0015-0282(24)00623-X. [PMID: 39067673 DOI: 10.1016/j.fertnstert.2024.07.027] [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: 04/09/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To investigate whether operative hysteroscopy in addition to vacuum aspiration for the management of early pregnancy loss effectively increases the success rate of subsequent frozen embryo transfer. DESIGN Propensity score-matched cohort study. SETTING Academic hospital. PATIENT(S) Women with a miscarriage at 5-16 gestational weeks during an in vitro fertilization cycle in Peking University Third Hospital from 2015 to 2022. INTERVENTION(S) Hysteroscopy plus vacuum aspiration vs. conventional vacuum aspiration. MAIN OUTCOME MEASURE(S) Live birth rate in the subsequent frozen embryo transfer. RESULT(S) A total of 347 women who underwent vacuum aspiration plus hysteroscopy and 2,562 women who underwent conventional vacuum aspiration were included in the analysis. After propensity score matching (1:1 ratio), 325 women were included in each group. Compared with women who underwent vacuum aspiration, those who underwent vacuum aspiration plus hysteroscopy were associated with a lower rate of live birth in the propensity score-based matched cohort (22% vs. 30%; adjusted odds ratio, 0.68 [0.47-0.97]). Biochemical, clinical, and multiple pregnancy rates were not significantly different, as was the miscarriage rate. In the overall cohort, 11 women experienced surgery reintervention in the vacuum aspiration group (0.4%), whereas none required surgery reintervention in the vacuum aspiration plus hysteroscopy group. CONCLUSION(S) Women who underwent vacuum aspiration plus hysteroscopy may be associated with lower rates of live birth than those who underwent vacuum aspiration. Further studies are necessary to establish this relationship definitively.
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Affiliation(s)
- Kai-Lun Hu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, People's Republic of China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, People's Republic of China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Jie Zhao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Mingmei Lin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiaoye Wang
- Birth Control Department, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Linjing Qi
- Birth Control Department, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Huan Liu
- Linyi Central Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Dan Mo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China; The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Zhonghong Zeng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China; The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Melbourne, Victoria, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, People's Republic of China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, People's Republic of China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, People's Republic of China.
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Tam T, Fernandez CM, Levine EM. Angular Pregnancy in an Arcuate Uterus: Hysteroscopic Management of Retained Products of Conception. J Minim Invasive Gynecol 2024; 31:88-89. [PMID: 37935332 DOI: 10.1016/j.jmig.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Teresa Tam
- Department of Obstetrics and Gynecology, Ascension Saint Francis Hospital, Evanston, Illinois (Dr. Tam); Advocate Aurora Illinois Masonic Medical Center, Chicago, Illinois (Drs. Tam and Fernandez).
| | - Carlos M Fernandez
- Advocate Aurora Illinois Masonic Medical Center, Chicago, Illinois (Drs. Tam and Fernandez)
| | - Elliot M Levine
- Rosalind Franklin University/ Chicago Medical School, North Chicago, Illinois (Dr. Levine)
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