Intrauterine adhesions after hysteroscopic treatment for retained products of conception What are the risk factors

Capsule:
Risk factors for intrauterine adhesions include retained products of conception (RPOC) occurring after delivery by cesarean section. Hysteroscopic treatment for RPOC has a low incidence of severe intrauterine adhesions formation.

Authors:
Oshri Barel, M.D., Ayala Krakov, M.D., Moty Pansky, M.D., Zvi Vaknin, M.D., Reuvit Halperin, M.D., Ph.D., Noam Smorgick, M.D., M.Sc.

Volume 103, Issue 3, Pages 775-779

Abstract:

Objective:
To assess the prevalence and risk factors for intrauterine adhesions (IUAs) after hysteroscopic treatment of retained products of conception (RPOC).

Design:
Retrospective cohort study.

Setting:
Gynecologic endoscopy unit.

Patient(s):
A total of 167 women referred to our institution from 2009 to 2013.

Intervention(s):
Operative hysteroscopy for treatment of RPOC and office hysteroscopic follow-up to assess for IUA.

Main Outcome Measure(s):
We investigated demographic characteristics, obstetrics parameters, and surgical variables to evaluate which factors could be associated with IUA formation.

Result(s):
Of 167 women treated for RPOC, 84 (50.3%) had undergone a follow-up hysteroscopic evaluation after the operative hysteroscopy and were included in the study. Intrauterine adhesions were found in 16 cases (19.0%), of which only 3 (3.6%) were severe adhesions. Multivariate analysis showed that the presence of IUA was associated with RPOC after cesarean section (5 of 10 [50.5%] developed IUA, vs. 7 of 49 [14.3%] after vaginal delivery). Intrauterine adhesions were also found in 4 of 23 women (17.4%) undergoing hysteroscopy for RPOC after abortion. Patient age, gravidity, parity, and the interval between the index pregnancy and treatment for RPOC were not associated with postoperative IUA.

Conclusion(s):
Hysteroscopic treatment for RPOC had a 3.6% incidence of severe intrauterine adhesions formation in this descriptive series. Women with RPOC occurring after delivery by cesarean section are particularly at risk for development of IUA.

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