Outpatient hysteroscopic removal of retained products of conception: evaluation of effectiveness, safety and patient satisfaction.

Objective: To assess effectiveness, safety and patient satisfaction of hysteroscopic removal of retained products of conception using a tissue removal system in the outpatient setting.

Study Design: A prospective observational study was carried out in a tertiary care hospital over a 10-month period. Fifty-two women who underwent an outpatient hysteroscopy for removal of retained products of conception were included. Effectiveness was evaluated as complete removal of retained products of conception in a one-time procedure. Safety was determined based on the rate of complications using the Clavien-Dindo classification system. Patient satisfaction and pain were assessed using a visual analogue scale survey completed by patients after the procedure.

Results: Complete removal of retained products of conception in a one-time procedure was achieved in 98.1% of cases. The mean morcellation time was 6.0 min. The complication rate recorded in this study was 9.6%; most complications were mild, but there was one case of uterine perforation. A global satisfaction ratio of 8.9 out of 10 was reported by patients. The study did not find any significant differences in complete removal of retained products of conception based on type of hysteroscope, presence of symptoms or Gutenberg classification. Although not significant, a linear relationship was observed between a higher volume of retained products of conception and a higher Gutenberg classification (p=0.229).

Conclusion: Outpatient management of retained products of conception using a tissue removal system is effective and safe, and has a high level of patient satisfaction. The results of this study have the potential to alter the standard approach to the management of retained products of conception.