BACKGROUND AND PURPOSE:

• Estimated incidence of post-D&C adhesions: 15% to 40%
• Vitale et al. (Journal of Minimally Invasive Gynecology, 2021) evaluated outcomes associated with hysteroscopy for retained POCs (RPOC) in a meta-analysis

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • Observational and randomized studies
  • Studies that analyzed surgical and/or reproductive outcomes of women who underwent hysterocopic removal of RPOC
• Study design
  • Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were followed
• Primary outcome
  • Complete resection rate (complete removal after 1 procedure)
• Secondary outcomes
  • Incomplete resection rate (requires ≥2 operative hysteroscopies) | Complication rate | Time between diagnosis and treatment

RESULTS:

• 20 studies | 2112 women
• Pooled complete resection rate with hysteroscopy
  • 91% (95% CI, 0.83 to 0.96)
• Incomplete resection rate
  • 7% (95% CI, 0.03 to 0.14)
• Complication rate
  • 2% (95% CI, 0.00 to 0.04)
• Postsurgical intrauterine adhesions reported
  • 0.8% (12 cases in 1478 procedures)
• Post-therapy pregnancy outcomes
  • Clinical pregnancy rate: 87% (95% CI, 0.75 to 0.95)
  • Live birth rate: 71% (95% CI, 0.60 to 0.81)
  • Pregnancy loss rate: 9% (95% CI, 0.06 to 0.12)
• Mean TDT: Ranged from 37 days to 109.2 days (11 studies)

CONCLUSION:

• Hysteroscopy successfully achieves complete removal of RPOC in approximately 90% of cases with low complication rates
• Adhesion rates were low, with high pregnancy and live birth rates
• The authors state

As technology has evolved, clinical practice should evolve as well

A century ago, the management of RPOC under direct visualization was not realistic

However, blind D&Cs for RPOC, postpartum hemorrhage, and more may need to be reconsidered because the complications are inversely proportional to visualization 

Learn More – Primary Sources:

Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis

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