September 15th, 2019

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Retained Products of Conception Following Delivery by Cesarean Section: Is It a Real Entity?
Authors:  Noam Smorgick, M.D., Hilli Zur, M.D., Orna Levinsohn-Tavor, M.D., Moshe Betser, M.D., Yosef Tovbin, M.D., and Moty Pansky, M.D.
  OBJECTIVE: To describe our experience with diagnosis and hysteroscopic treatment of retained products of conception (RPOC) following cesarean delivery (CD).

STUDY DESIGN: A retrospective study of all women who underwent hysteroscopy for treatment of suspected RPOC following CD. Their obstetrical history, clinical presentation, ultrasound and hysteroscopic findings, and pathology reports were reviewed and analyzed.

RESULTS: A total of 24 cases were identified out of 11,170 CDs during the study period (0.21%). In 17 (70.8%) women, no difficulty was encountered in the removal of the placenta dur-ing CD, while in the remaining 7 (29.2%) the surgeon identified an adherent placenta which could not be separated easily. On hysteroscopy, complete RPOC removal on the first hysteroscopic procedure was possible in 21/24 (87.5%) cases, while 3 women underwent 2 hysteroscopic procedures. No intraoperative complications occurred. On follow-up office hysteroscopy a normal uterine cavity was observed in 14/18 (77.7%), minimal adhesions were seen in 3 (16.7%) cases, and there were severe adhesions in 1 case (5.6%).

CONCLUSION: Although rare, RPOC following CD may occur. Treatment by hysteroscopy is feasible and has the advantage of low rates of complications and postoperative intrauterine adhesions.
Keywords:  cesarean section, hysteroscopy, placenta accreta, residual trophoblastic tissue, retained placenta, retained products of conception, trophoblasts
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