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See‐and‐treat in‐office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study
Author(s) -
Raz Nili,
Sigal Emiliya,
Gonzalez Arjona Fernando,
Calidona Carmelo,
Garzon Simone,
Uccella Stefano,
Laganà Antonio Simone,
Haimovich Sergio
Publication year - 2022
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.15327
Subject(s) - hysteroscopy , medicine , products of conception , uterine perforation , surgery , retrospective cohort study , perforation , pregnancy , research methodology , abortion , population , materials science , environmental health , biology , family planning , metallurgy , punching , genetics
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.