CLINICAL ARTICLE A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception Ido Ben-Ami ⁎, Yaakov Melcer, Noam Smorgick, David Schneider, Moty Pansky, Reuvit Halperin 1 Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel abstract article info Article history: Received 3 January 2014 Received in revised form 29 April 2014 Accepted 12 June 2014 Keywords: Curettage Hysteroscopy Infertility Residual trophoblastic tissue Retained products of conception Objective: To compare the reproductive outcome of women who underwent blind dilatation and curettage (D&C) with those who underwent hysteroscopic resection of pathologically confirmed retained products of conception (RPOC). Methods: Medical records of women who underwent either D&C or hysteroscopic resection of RPOC at Assaf Harofeh Medical Center, Israel, between 2000 and 2010 were retrospectively reviewed. Results: A total of 177 women with pathologically confirmed RPOC underwent either D&C (n = 94, 53.1%) or hysteroscopy (n = 83, 46.9%). Mean time to conception was significantly shorter after hysteroscopy than after D&C (7.4 ± 7 vs 12.9 ± 16.8 months, P = 0.037). Rate of occurrence of a newly diagnosed infertility problem was significantly higher following D&C than hysteroscopy (23 [24.5%] vs 10 [12.0%]; P = 0.034). Etiology of the new problem was mechanical, including tubal occlusion and intrauterine adhesions. Logistic regression comparing both methods revealed that hysteroscopic resection was associated with a significant reduction in the occurrence of a new infertility problem compared with D&C (OR 0.42; 95% CI, 0.18–0.96, P = 0.04). Conclusion: Hysteroscopic removal of RPOC is associated with a shorter mean time to further conception and a lower rate of occurrence of newly diagnosed infertility problems than D&C. © 2014 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. 1. Introduction Retained products of conception (RPOC) describes fetal and/or pla- cental tissue that persists in the uterus following spontaneous abortion, induced abortion, or delivery. It complicates approximately 1% of all pregnancies and is most common after pregnancy termination (both spontaneous and induced), although it may also occur after spontane- ous vaginal delivery and cesarean delivery [1–3]. Trauma to the gravid uterus in the postpartum period, after cesarean delivery [4], or after spontaneous or induced abortion [5,6] is considered to be the major cause of intrauterine adhesions (IUAs) and Asherman syndrome, which are manifested clinically by menstrual abnormalities, infertility, and recurrent pregnancy loss [7]. Traditionally, dilatation and curettage (D&C) has been the method of choice for the management of RPOC [8]. Hysteroscopic resection of RPOC is an alternative to nonselective, blind curettage [9] and allows highly selective removal that is limited to the RPOC without affecting the adjacent endometrium [10]. There is limited data available regarding the reproductive outcome of women who had hysteroscopic resection of RPOC compared with those who had nonselective, blind curettage. A comparison of 24 women who underwent D&C and 46 women who underwent hystero- scopic resection of RPOC revealed similar reproductive outcome in both groups, with a trend to conceive earlier in the hysteroscopy group, but no difference in overall pregnancy rates [11]. In an observational study of 50 women over a 6-year period, hysteroscopic resection of late RPOC was found to be feasible, efficient, and have good reproductive outcome [12]. However, since women who underwent D&C were not included in this study, a comparison between the two treatment modal- ities was not possible. Finally, a cohort study in 2011 compared the re- productive outcome of patients who underwent ultrasound-guided curettage (n = 42) with those who underwent hysteroscopic resection (n = 53) of RPOC [10]. A statistically significant higher conception rate was found in the patients who underwent hysteroscopy than in those who had curettage. Furthermore, patients who underwent hysterosco- py had a significantly shorter time to conception. However, women with RPOC following spontaneous vaginal delivery were not included in this study and all patients had undergone a previous uterine inter- vention (D&C or cesarean delivery) [10]. International Journal of Gynecology and Obstetrics xxx (2014) xxx–xxx ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, 70300, Israel. Tel.: +972 8 9779000; fax: +972 8 9778250. E-mail address: idorit@netvision.net.il (I. Ben-Ami). 1 This manuscript is dedicated to the late Prof. Reuvit Halperin. Her devotion to her pa- tients and passion for both surgery and research were legendary. She is greatly missed by all who knew her. IJG-08005; No of Pages 4 http://dx.doi.org/10.1016/j.ijgo.2014.05.003 0020-7292/© 2014 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo Please cite this article as: Ben-Ami I, et al, A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception, Int J Gynecol Obstet (2014), http://dx.doi.org/10.1016/j.ijgo.2014.05.003