Office Operative Hysteroscopy for the Management of Retained Products of Conception

Abstract

Study Objective Office operative hysteroscopy (See-and-treat) allows most women with abnormal ultrasound findings suspected for retained products of conception (RPOC) to avoid the added risks of anesthesia and the inconvenience of the operating room. The aim of this study is to compare office to conventional operative hysteroscopy for the treatment of RPOC. Design A retrospective cohort study from January 2018 to March 2019. Setting Single tertiary medical care center. Patients or Participants All women who underwent hysteroscopy due to RPOC during the study period. Interventions Data were collected from women's medical records. Primary outcome was defined as successful removal of all suspected RPOC. Data are presented as median and interquartile range. Measurements and Main Results During the study period, 229 women underwent hysteroscopy due to RPOC, of them 141 (61.57%) and 88 (38.43%) office and conventional operative hysteroscopy, respectively. No in-between group differences were observed in women's age, body mass index and parity. Time interval to hysteroscopy was longer [ 2.13 (1.55-2.78) vs. 1.63 (1.02-1.63) month; p=0.001], and maximal diameter of thesuspected finding was smaller for the office group compared to the conventional operative group [12.0 (8-20) vs. 20 (15-30) mm; p=0.001]. Positive finding rate on histho-pathology was higher for the operative group (76.1% vs. 61.0%; p=0.02). Additional analysis comparing success (n=111) to failure (n=30) of office operative hysteroscopy, revealed that maximal diameter ≤27.5 mm had significantly higher success rate (p=0.007). This finding was supported by logistic regression analysis that found maximal diameter of the suspected finding as the only parameter associated with success rate in office operative hysteroscopy (B=0.12; p=0.001). Conclusion Office operative hysteroscopy is a feasible treatment option for the removal of RPOC when maximal content dimeter is taken under consideration due to its association to success rate.