Does Procedure Time and Size Matter for Office Hysteroscopy Treatment of Retained Products of Conception?

Abstract

<h3>Study Objective</h3> To establish the procedure time (PT) and mean size of retained products of conception (RPOC) treated in office hysteroscopy (OH). <h3>Design</h3> Retrospective Study (Canadian Task Force II- b). <h3>Setting</h3> Private Office Setting. <h3>Patients or Participants</h3> Patients with RPOC with or without prior treatment. <h3>Interventions</h3> Patients treated with a 5 mm continuous flow office hysteroscope, or Truclear^TM 5C System, or with 16 Fr resectoscope. <h3>Measurements and Main Results</h3> A total of 486 cases were reviewed, and 137 cases were included. 74(54%) patients had a PUS, and adherent RPOC was found in 6 (4.4%) (Chi - square analysis, p=-021) patients, all of which had a PUS. Descriptive analysis found the overall intra-operative visual analogue score (VAS) of pain < 5 to be 96.9 % and the Likert's scale of satisfaction with the procedure to be high (93.4%). The overall mean PT is 14.2±8 (mean±SD) min & the overall mean size is 2.1±.8 cm, and in PUS group it is 15±9 min & 2.2±.8 cm. Independent samples test was applied to variables, and no significant difference was found in VAS or satisfaction rates with or without PUS, but as the overall PT increases, the VAS increases (.307; sig(2-tailed)=.00) and satisfaction rate decreases (-.219; sig(2-tailed)=.01). Truclear had the shortest duration at 10±4 min(p=.00). 127(87.6%) patients who were very satisfied with the procedure, had a PT of 13.6±8 min(p=.064) & size of 2.1±.9 cm. The ROC curve was plotted for the PT and the size of RPOC. The PT was > 6.5 min in patients who had a PUS (86.5% sensitivity), but the specificity is low (14.3%), therefore, even in patients who had no PUS, the PT may be > 6.5 min. A risk of RPOC size > 1.55 cm is higher in PUS with 77% sensitivity and 42.9% specificity. <h3>Conclusion</h3> Women reported highest satisfaction with RPOC of size < 2.1 cm and the procedure time of < 14 min.