Evaluation of fertility after operative hysteroscopy to remove retained products of conception

Abstract

Evaluation of fertility after operative hysteroscopy to remove retained products of conception.

Objective: To study fertility after operative hysteroscopy for the management of prolonged trophoblastic retention, and the complications of this procedure.

Study design: Retrospective cohort in a university hospital.

Results: 115 patients underwent operative hysteroscopy for the treatment of prolonged post-partum and post-abortum retention between January 2008 and December 2011. Of the 115 patients included in this study, 53 desired a postoperative pregnancy. Using the survival model, the conception rate was 71.1% (95%CI; 58.1-82.9) at 6 months and 83.5% (95%CI; 71.8-92.2) at 1year. The overall rate of intraoperative complications was 15%. The rate of complications≥grade 3 was 5%. Logistic regression analysis showed that only retentions of greater than 25mm were associated with complications generally (aOR=7.4; 95%CI; 2.3-24.5) and with Clavien-Dindo complications≥grade 3 (OR=27.2; 95%CI; 2.8-263).

Conclusion: The management of prolonged retention by operative hysteroscopy allows the preservation of future fertility. There are more complications when the retentions are >25mm.

Keywords: Fertility; Operative hysteroscopy; Residual trophoblastic tissue.