Operative Hysteroscopic Management of Persistent Retained Products of Conception

Abstract

<h3>Study Objective</h3> The objective of this video is to demonstrate the use of operative hysteroscopy for persistent retained products of conception after failure of medical and/or surgical (i.e., suction, dilation & curettage) methods. <h3>Design</h3> N/A. <h3>Setting</h3> Academic Medical Center – A 22-year-old G3P1011 multigravida with one prior vaginal delivery presented to the emergency room with vaginal bleeding and was incidentally found to be pregnant with a serum bHCG value greater than 200,000. The patient was diagnosed with an embryonic pregnancy via transvaginal ultrasound and counseled on medical versus surgical management. The patient opted for a suction, dilation and curettage under ultrasound guidance. The procedure was uncomplicated, and the endometrial stripe was noted to be thin and uniform at the conclusion of the procedure. The patient continued to have vaginal bleeding and persistent serum bHCG levels in the post-operative period. Repeat transvaginal ultrasound demonstrated a thickened endometrium without a gestational sac and a small amount of free fluid in the pelvis. The bilateral adnexa were normal in appearance. The patient underwent operative hysteroscopy with successful resection of densely adhered, fibrotic-appearing retained products of conception. The patient had resolution of her vaginal bleeding and persistent serum bHCG levels with resumption of her normal menses. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Operative hysteroscopy with a tissue removal system. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> We propose that operative hysteroscopy be given consideration as a safe and effective surgical intervention option in a premenopausal, hemodynamically stable patient, with absent or stable vaginal bleeding, and diagnosed with one of the following: anembryonic pregnancy, missed abortion, retained products of conception, or an abnormally developing intrauterine pregnancy as demonstrated by inappropriate rise in serum bHCG, to offer more targeted treatment while considering future fertility goals.