Ganer Herman Hadas, Kogan Zviya, Tairy Daniel, Ben Zvi Masha, Kerner Ram, Ginath Shimon, Bar Jacob, Sagiv Ron
Gynecol Obstet Invest. 2018;83(6):586-592. doi: 10.1159/000489496. Epub 2018 Jun 26.
To compare clinical variables, sonographic findings and pregnancy outcomes following the hysteroscopic removal of retained products of conception (RPOC) after delivery and abortion.
This is a retrospective cohort of operative hysteroscopies performed between 2011 and 2015 for suspected RPOC, during which trophoblastic tissue was obtained. Patient demographics, clinical presentation, sonographic evaluation, subsequent infertility and pregnancy outcomes were compared between post-delivery (n = 85) and post-abortion (n = 93) cases.
The main presenting symptom in both study groups was vaginal bleeding. On sonographic evaluation, maximal endometrial thickness was significantly higher in the post-delivery group, while irregularity and increased flow were more common in the post-abortion group. There was a similar rate of deliveries following hysteroscopy in both groups with 40% in the post-delivery group and 39.7% in the post-abortion group. Deliveries in the post-delivery group were characterized by a higher rate of abnormal placentation - 30.5% - including low lying placenta and placenta accreta. A significant rate of vaginal deliveries in both groups entailed manual removal of the placenta or exploration of the uterine cavity (23.5 and 10.5%, p = 0.20).
Pregnancies following RPOC after delivery entail a higher rate of abnormal placentation.
比较分娩及流产后宫腔镜切除妊娠物残留（RPOC）后的临床变量、超声检查结果及妊娠结局。
这是一项回顾性队列研究，纳入2011年至2015年间因疑似RPOC而行宫腔镜手术且获取滋养层组织的患者。比较分娩后（n = 85）和流产后（n = 93）病例的患者人口统计学资料、临床表现、超声评估、后续不孕情况及妊娠结局。
两个研究组的主要症状均为阴道出血。超声评估显示，分娩后组的最大子宫内膜厚度显著更高，而流产后组内膜不规则及血流增加更为常见。两组宫腔镜检查后的分娩率相似，分娩后组为40%，流产后组为39.7%。分娩后组分娩的特点是胎盘异常发生率较高——30.5%——包括前置胎盘和胎盘植入。两组中相当比例的阴道分娩需要人工剥离胎盘或探查宫腔（分别为23.5%和10.5%，p = 0.20）。
分娩后RPOC后的妊娠胎盘异常发生率较高。
