Hysteroscopic Removal of Retained Products of Conception Implanted Over a Focal Area of Adenomyosis

A report describes a case of a 35-year-old patient who presented with persistent bleeding for over five weeks. She described a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging showed the presence of adenomyosis. 

She also described experiencing an unfortunate spontaneous abortion at eight weeks of gestation. Physical examination revealed a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound showed an intrauterine hyperechogenic vascularized area of 2 × 2, 8 × 2 cm implanted over a focal area of adenomyosis, indicating the presence of retained products of conception (RPOC). 

She received a hysteroscopic approach to minimize possible acute complications (bleeding, infection, and uterine perforation) and to avoid performing a blind dilation and curettage. Furthermore, a hysteroscopic approach also lowers the incidence of long-term complications such as intrauterine adhesions and the consequent Asherman syndrome. 

This report describes that Hysteroscopic removal of RPOC is a feasible and safe management option for this pregnancy complication. Healthcare professionals must avoid performing blind procedures such as dilation and curettage, and they should adopt this modality to remove retained products of conception under direct visualization.

Alonso L, Nieto L, Carugno J. Hysteroscopic Removal of Retained Products of Conception Implanted Over a Focal Area of Adenomyosis: A Case Report. J Minim Invasive Gynecol. 2018 Mar-Apr;25(3):382-383. doi: 10.1016/j.jmig.2017.09.010. Epub 2017 Sep 20. PMID: 28939480.