Research and Reports in Gynecology and Obstetrics

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The use of hysteroscopic morcellation in the outpatient management of retained products of conception.

Retained products of conception (RPOC) can prove challenging to manage, particularly in cases where conventional treatment options have failed. There are well-documented risks associated with recurrent dilatation and curettage, even when done under ultrasound guidance. Hysteroscopic resection has been described in the literature as an alternative surgical treatment option, but again this is not without risks. A further alternative treatment option is the use of hysteroscopic morcellation, which is already well established and successfully used in the outpatient management of uterine pathologies, such as endometrial polyps and fibroids. Like formal hysteroscopic resection, it allows targeted removal of the retained products under direct vision, but instead uses a mechanical blade thus avoiding the use of heat energy and the potential risks of fluid overload and visceral heat injury. We present a retrospective case series of 9 cases where hysteroscopic morcellation was used to resect RPOC in the outpatient setting in cases where standard management options had failed. Hysteroscopic morcellation was found to be a safe and effective means of treating persistent RPOC with complete resection and symptom resolution in 100% of cases and no intraoperative or postoperative complications noted. The procedure was quick and well tolerated by patients in the outpatient setting with low pain scores and thus should be considered as a potential alternative surgical treatment option in the management of RPOC, particularly when other standard treatment options have failed.

Author(s): Rebecca Mallick and Bronwyn Middleton