Abstract
Purpose
This study aimed to assess the rates of retained products of conception (RPOC) after routine postpartum evaluation of patients who underwent post-delivery manual uterine revision due to retained placenta.
Methods
This is a retrospective cohort study of 599 consecutive women who underwent manual removal of placenta during 2010–2018. Group A comprised 465 women who underwent postpartum symptom-based evaluation (2010–2016). Group B comprised 134 women who were routinely evaluated by ultrasound and subsequently by hysteroscopic examination 6 weeks after delivery (2016–2018).
Results
The rates of abnormal postpartum bleeding were similar between groups A and B (12% and 13%, respectively, p = 0.72%). A significantly smaller proportion of women underwent hysteroscopy in group A than group B (12% vs. 37%, p < 0.05). The rate of persistent RPOC confirmed by hysteroscopy was significantly lower in group A than group B (9.7% vs. 23%, p < 0.05).
Conclusion
Among patients who underwent post-delivery manual removal of placenta, a threefold higher rate of RPOC was discovered by routine elective evaluation than by evaluating only symptomatic patients. Future studies may show whether this approach translates to an effect on fertility.
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References
Deneux-Tharaux C, Macfarlane A, Winter C, Zhang WH et al (2009) Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe. BJOG 116:119–124
Weeks AD (2008) The retained placenta. Best Pract Res Clin Obstet Gynaecol 22:1103–1117
Cheung WM, Hawkes A, Ibish S, Weeks AD (2011) The retained placenta: historical and geographical rate variations. J Obstet Gynaecol 31:37–42
Combs CA, Laros RK (1991) Prolonged third stage of labor: morbidity and risk factors. Obstet Gynecol 77:863–867
Weeks AD (2003) Placental influences on the rate of labour progression: a pilot study. Eur J Obstet Gynecol Reprod Biol 106:158–159
Hrazdirova L, Svabik K, Zizka Z, Germanova A, Kuzel D (2012) Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery? Acta Obstet Gynecol Scand 91:514–517
Rosenstein MG, Vargas JE, Drey EA (2014) Ultrasound-guided instrumental removal of the retained placenta after vaginal delivery. Am J Obstet Gynecol 211(180):e1–e3
Weissbach T, Haikin-Herzberger E, Bacci-Hugger K, Shechter-Maor G, Fejgin M, Biron-Shental T (2015) Immediate postpartum ultrasound evaluation for suspected retained placental tissue in patients undergoing manual removal of placenta. Eur J Obstet Gynecol Reprod Biol 192:37–40
Anteby M, Many A, Ashwal E, Yogev Y, Shinar S (2019) Risk factors and complications of manual placental removal after vaginal delivery: How common are additional invasive procedures? J Matern Fetal Neonatal Med 32:384–388
Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP (2005) Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol 105:1104–1113
Nanda K, Peloggia A, Grimes D, Lopez L, Nanda G (2006) Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev 2:CD003518
Barel O, Krakov A, Pansky M, Vaknin Z, Halperin R, Smorgick N (2015) Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors? Fertil Steril 103:775–779
Hooker AB, Muller LT, Paternotte E, Thurkow AL (2015) Immediate and long-term complications of delayed surgical management in the postpartum period: a retrospective analysis. J Matern Fetal Neonatal Med 28(16):1884–1889
Melcer Y, Smorgick N, Schneider D, Pansky M, Halperin R, Ben-Ami I (2016) Infertility Following retained products of conception: Does the timing of surgical ıntervention matter? Isr Med Assoc J 18:605–608
Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z (2013) A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. Eur J Obstet Gynecol Reprod Biol 171(1):143–145
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AN: manuscript writing–editing, data analyzing; NE: data collection, data analyzing; EI: data collection; EZ: data analyzing; SS: data analyzing; VK: data analyzing; EYA: manuscript editing, supervsior; OG: Supervisor, project administration, manuscript editing.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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The study was designed as a retrospective study. All data was collected anonymously. The Ethical board waived informed consent.
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Namazov, A., Elkabetz, N., Ivshin, E. et al. Routine ultrasonographic and hysteroscopic evaluations of women undergoing postpartum manual removal of placenta: a retrospective cohort study. Arch Gynecol Obstet 301, 715–719 (2020). https://doi.org/10.1007/s00404-020-05433-5
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DOI: https://doi.org/10.1007/s00404-020-05433-5