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Hysteroscopic removal of retained products of conception with enhanced vascularity: a study of reliability |
G. Garuti1, *( ), E. Castellacci2, S. Calabrese1, S. Calzolari2 |
1Obstetrics and Gynecology Department, Public Hospital of Lodi, Lodi, Italy 2Public Hospital Palagi, Florence, Italy |
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Abstract
Purpose of Investigation: Retained products of conception (RPOC) is the leading cause of postpartum or post-abortion hemorrhage. RPOC showing high vascularity at ultrasound assessment (HV-RPOC) showed an enhanced hemorrhagic risk following blind surgical uterine emptying. The authors describe the clinical outcome of patients suffering from HV-RPOC undergoing hysteroscopic removal. Material and Methods: Cohort of symptomatic patients suffering from HV-RPOC following miscarriages, pregnancy terminations, and term deliveries. After ultrasound selection based on color-Doppler showing HV-RPOC, all patients underwent hysteroscopic resection. Results: Twenty-seven patients met the selection criteria. HV-RPOC were found in 14 and six women after first and second trimester pregnancy termination, respectively. In seven women RPOC were found after term delivery. In 18 women (66.6%) RPOC were found firmly adherent to myometrium. Neither intra- nor postoperative complications were recorded. Hysteroscopy follow-up was carried-out in 16 patients. Normal findings were found in 15 women in one case a mild adhesion was observed. Conclusion: HV-RPOC are often characterized by abnormally adherent placenta, suggesting that an accreta can be an underlying etiology. A reliable management can be accomplished by hysteroscopic resection.
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Submitted: 19 May 2019
Accepted: 01 August 2019
Published: 15 August 2020
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*Corresponding Author(s):
GIANCARLO GARUTI
E-mail: giancarlo.garuti@tiscali.it
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