Hysteroscopic Treatment of Retained Products of Conception Using See and Treat Operative Office Hysteroscopy Without Anesthesia

Study objective: To evaluate clinical efficacy of office operative hysteroscopic treatment of retained products of conception (RPOC) without anesthesia.

Design: A retrospective cohort study.

Setting: A tertiary care academic medical center between April 2019 to March 2023.

Patients: A total of 175 patients with confirmed RPOC underwent see-and-treat operative office hysteroscopy without anesthesia in our outpatient clinic.

Interventions: Hysteroscopic removal of RPOC without anesthesia.

Measurements and main results: In 163 cases, the removal of RPOC in the office was attempted, and in 155 cases (95.1%), complete removal of the RPOC without complications was achieved, although it sometimes required a second procedure in clinic. In 12 cases, office operative hysteroscopy was not attempted due to physician decision based on the appearance and vascularity of RPOC, or due to pain during the diagnostic hysteroscopy, or both. The average size of RPOC for patients treated in the clinic was 15 ± 8.4 mm (range 4-47 mm). One hundred twenty-eight cases were performed using a Truclear Elite 6 mm device, and 35 cases using a mini-Bettocchi 4.2 mm device. Eighteen cases were unsuccessful on the first attempt; 12 underwent a second procedure in the clinic, which was completed in 10 (83.3%) cases. Of the patients, 105 (71.4%) patients attended a follow-up hysteroscopy, 8 of them (7.6%) required separation of adhesions that were performed in the clinic, and 8 patients were referred to a surgical procedure under anesthesia due to persistent RPOC.

Conclusion: Operative office hysteroscopy is feasible and highly effective for patients with RPOC, with a total success rate of 95.1% complete evacuation in clinic. A follow-up hysteroscopy is important, especially after treatment of large RPOC.