Hysteroscopic Control of Uterine Cavity Following Manual Removal of Placenta or Early Postpartum Curettage

Abstract

Objective: The aims of this study were to assess the morbidity associated with manual removal of the placenta (MRP) and early postpartum curettage (PPC) via hysteroscopy and to assess whether the mode of delivery in patients who underwent MRP, pathology results of specimens obtained via PPC, and history of cervical laceration or episiotomy in vaginal delivery associated with morbidity related to intrauterine adhesions. Design: A trial was conducted, including 60 women who underwent MRP (group 1) and 60 women who underwent PPC (group 2) having delivered at Zeynep Kamil Maternity and Child Research and Training Hospital, Uskudar, in Istanbul, Turkey, over a 2-year period; and 30 women who were healthy served as controls (group 3). Materials and Methods: Diagnostic hysteroscopy was performed on all of the subjects. The findings in these three groups were compared. The relationships among the hysteroscopic findings and data obtained via a retrospective chart review were analyzed. The correlations between patients' characteristics and prevalence of intrauterine adhesion (IUA) were assessed with chi-square and Fisher's exact test calculations. Results: The percentage of postpartum interventions that needed general anesthesia was about 1%. A total of 150 patients were included in the study. Three grade 1 adhesions (5%) in group 1; 2 grade 3, 5 grade 2, and 4 grade 1 adhesions (total: 11 adhesions, 18.3%) in group 2; and 1 grade 1 adhesion (3.3%) in group 3 were detected. There was no statistical association between any factor and adhesions in any group, but there was a negative association between a history of episiotomy and adhesions in group 2. Uterine perforation was not detected in any group. Four blood transfusions were needed in group 2. Three postoperative pyrexias were observed. Two of the cases with postoperative pyrexia occurred following blood transfusions. Prophylactic antibiotics were used for all patients in groups 1 and 2. The operation was not repeated in group 2. Two subseptus cases (uterine anomalies) were detected in group 2. Pathologic examination results of biopsy materials of 4 patients in group 2 revealed the presence of fibrotic tissue, but there was not enough material from other patients with adhesions for pathologic examination. Conclusions: There is no firm evidence to justify carrying out routine diagnostic hysteroscopy following MRP or PPC. But, patients who have a history of PPC and have menstrual abnormalities, such as hypomenorrhea, may be evaluated via hysteroscopy. The negative association between the presence of episiotomy and adhesions needs further study to be explained. (J GYNECOL SURG 25:83)