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Grand Rounds

Meta-analysis: Hysteroscopic Removal of RPOCs

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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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Related ObG Topics:

Can Operative Hysteroscopy Improve Fetal Chromosome Detection Following Miscarriage?
Which Pharmacological Intervention is Best for Managing Retained Placenta?
Does Antibiotic Prophylaxis Reduce the Risk of Infection Following Surgical Procedures for Incomplete Miscarriage?

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