Routine ultrasonographic and hysteroscopic evaluations of women undergoing postpartum manual removal of placenta: a retrospective cohort study

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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.


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).


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).


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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Author information

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.

Correspondence to Ahmet Namazov.

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The authors declare that they have no conflict of interest.

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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 (2020) doi:10.1007/s00404-020-05433-5

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  • Retained products of conception (RPOC)
  • Manual removal
  • Placenta
  • Hysteroscopy
  • Ultrasound