Abstract：
Traditionally, curettage has been the most widely performed surgical intervention for removing retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative because of the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetrical outcomes were limited, and data conflicting.
This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration.
This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration.
A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P=.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P=.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P=.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P=1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0-17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0-12.1) in the electric vacuum aspiration group (P=.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P=.350).
Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.
This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration.
This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration.
A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P=.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P=.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P=.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P=1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0-17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0-12.1) in the electric vacuum aspiration group (P=.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P=.350).
Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.
摘要：
背景：传统上，刮宫术是去除保留的受孕产物的最广泛的外科手术。然而,由于宫腔粘连的潜在风险较低,完全切除率较高,因此宫腔镜下切除作为替代方案越来越多.直到最近,比较刮宫术和宫腔镜下切除生殖和产科结局的研究有限，数据冲突。
目的：本研究旨在评估通过宫腔镜或超声引导下的电真空抽吸取出保留的受孕产物后希望受孕的女性的生殖和产科结局。
方法：这是一项前瞻性长期随访研究，在3家教学医院和1家大学医院进行。从2015年4月至2022年6月纳入患者进行随访，无论是在随机对照中，关于去除保留的受孕产品后宫腔粘连风险的非盲试验，或在随机试验旁边的队列中。超声图像提示保留1至4厘米的受孕产品的女性符合条件。随机对照试验中的外科手术是宫腔镜切碎术或超声引导下的电真空抽吸术。在队列研究中，与超声引导下的电真空抽吸术相比，宫腔镜治疗包括宫腔镜碎裂术或冷环形切除术。
结果：305例患者中有261例（85.6％）在取出残留的受孕产物后可进行随访，通过超声引导下的真空抽吸术，研究了171名宫腔镜摘除后的女性和90名女性。分别,宫腔镜切除组的171名妇女中有92名（53.8％），电真空抽吸组的90名妇女中有56名（62.2％）希望怀孕（P=.192）。宫腔镜切除术后的后续妊娠率为91例（96.7％）中的88例，电真空抽吸术后的56例（92.9％）中的52例（P=.428）。宫腔镜切除和电真空抽吸后，活产率为80例61例（76.3％）和48例37例（77.1％），分别(P=.914)，宫腔镜切除组88例妊娠中有8例(9.1%),电真空抽吸组52例中有4例(7.7%)仍在随访中(P=1.00).受孕的中位时间为8.2周(四分位距，5.0-17.2）在宫腔镜切除组和6.9周（四分位数范围，5.0-12.1）在电真空抽吸组中（P=.262）。宫腔镜下摘除组的总胎盘并发症发生率为80例（16.3％）中的13例，电真空抽吸组为48例（22.9％）中的11例（P=.350）。
结论：宫腔镜切除和超声引导下的电真空抽吸保留的受孕产物似乎对随后的活产率没有显着不同的影响，怀孕率,受孕的时间，或妊娠并发症。去除保留的受孕产物后的生殖和产科结果令人放心，尽管胎盘并发症的风险很高。
目的：本研究旨在评估通过宫腔镜或超声引导下的电真空抽吸取出保留的受孕产物后希望受孕的女性的生殖和产科结局。
方法：这是一项前瞻性长期随访研究，在3家教学医院和1家大学医院进行。从2015年4月至2022年6月纳入患者进行随访，无论是在随机对照中，关于去除保留的受孕产品后宫腔粘连风险的非盲试验，或在随机试验旁边的队列中。超声图像提示保留1至4厘米的受孕产品的女性符合条件。随机对照试验中的外科手术是宫腔镜切碎术或超声引导下的电真空抽吸术。在队列研究中，与超声引导下的电真空抽吸术相比，宫腔镜治疗包括宫腔镜碎裂术或冷环形切除术。
结果：305例患者中有261例（85.6％）在取出残留的受孕产物后可进行随访，通过超声引导下的真空抽吸术，研究了171名宫腔镜摘除后的女性和90名女性。分别,宫腔镜切除组的171名妇女中有92名（53.8％），电真空抽吸组的90名妇女中有56名（62.2％）希望怀孕（P=.192）。宫腔镜切除术后的后续妊娠率为91例（96.7％）中的88例，电真空抽吸术后的56例（92.9％）中的52例（P=.428）。宫腔镜切除和电真空抽吸后，活产率为80例61例（76.3％）和48例37例（77.1％），分别(P=.914)，宫腔镜切除组88例妊娠中有8例(9.1%),电真空抽吸组52例中有4例(7.7%)仍在随访中(P=1.00).受孕的中位时间为8.2周(四分位距，5.0-17.2）在宫腔镜切除组和6.9周（四分位数范围，5.0-12.1）在电真空抽吸组中（P=.262）。宫腔镜下摘除组的总胎盘并发症发生率为80例（16.3％）中的13例，电真空抽吸组为48例（22.9％）中的11例（P=.350）。
结论：宫腔镜切除和超声引导下的电真空抽吸保留的受孕产物似乎对随后的活产率没有显着不同的影响，怀孕率,受孕的时间，或妊娠并发症。去除保留的受孕产物后的生殖和产科结果令人放心，尽管胎盘并发症的风险很高。
