A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception.

Objective: To compare the reproductive outcome of women who underwent blind dilatation and curettage (D&C) with those who underwent hysteroscopic resection of pathologically confirmed retained products of conception (RPOC).

Methods: Medical records of women who underwent either D&C or hysteroscopic resection of RPOC at Assaf Harofeh Medical Center, Israel, between 2000 and 2010 were retrospectively reviewed.

Results: A total of 177 women with pathologically confirmed RPOC underwent either D&C (n=94, 53.1%) or hysteroscopy (n=83, 46.9%). Mean time to conception was significantly shorter after hysteroscopy than after D&C (7.4±7 vs 12.9±16.8 months, P=0.037). Rate of occurrence of a newly diagnosed infertility problem was significantly higher following D&C than hysteroscopy (23 [24.5%] vs 10 [12.0%]; P=0.034). Etiology of the new problem was mechanical, including tubal occlusion and intrauterine adhesions. Logistic regression comparing both methods revealed that hysteroscopic resection was associated with a significant reduction in the occurrence of a new infertility problem compared with D&C (OR 0.42; 95% CI, 0.18-0.96, P=0.04).

Conclusion: Hysteroscopic removal of RPOC is associated with a shorter mean time to further conception and a lower rate of occurrence of newly diagnosed infertility problems than D&C.