Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, Zeriffin, Beer Yaakov, Israel; affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, Zeriffin, Beer Yaakov, Israel; affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
J Minim Invasive Gynecol. 2022 Mar;29(3):424-428. doi: 10.1016/j.jmig.2021.11.006. Epub 2021 Nov 18.
Retained products of conception (RPOC) may occur after delivery or abortion, often necessitating operative hysteroscopy for their removal. A preoperative diagnosis of RPOC by ultrasonography is not always accurate and may lead to unnecessary surgical procedures. We sought to evaluate whether serum level of β-human chorionic gonadotropin (β-HCG) may aid in the preoperative diagnosis of RPOC.
A prospective cohort study.
Gynecology department in a university affiliated medical center.
Women undergoing operative hysteroscopy for removal of RPOC between December 2019 and January 2021.
Operative hysteroscopy for RPOC removal. Serum β-HCG levels were obtained on the day of surgery, and level ≥5.0 mIU/mL was considered positive. All operative specimens were evaluated by pathology for the presence of trophoblastic tissue.
Of the 105 women recruited to the study, the operative pathology showed trophoblastic tissue in 81 cases (77.1%), and they were included in the data analysis. The β-HCG level was positive in 16 of those 81 cases (19.8%). Positive β-HCG level was significantly associated with RPOC after an abortion (surgical or medical) compared with RPOC after delivery. In addition, the mean RPOC mass was larger in the β-HCG-positive group than the β-HCG-negative group (29.1 ± 9.5 mm vs 23.8 ± 8.9 mm, respectively, p = .004), and the interval from termination of pregnancy to surgery was shorter (4.8 ± 1.7 weeks vs 7.5 ± 2.1 weeks, respectively, p <.001). Relatively high β-HCG level (352 mIU/mL and 3561 mIU/mL) were found in 2 cases in which the RPOC mass was implanted on a previous cesarean section scar.
β-HCG level is noncontributory to the preoperative diagnosis of RPOC.
流产或分娩后可能会发生妊娠组织残留（RPOC），通常需要手术宫腔镜来清除。超声检查对 RPOC 的术前诊断并不总是准确的，可能会导致不必要的手术。我们试图评估血清 β-人绒毛膜促性腺激素（β-HCG）水平是否有助于 RPOC 的术前诊断。
前瞻性队列研究。
一所大学附属医院的妇科。
2019 年 12 月至 2021 年 1 月期间因 RPOC 行手术宫腔镜切除术的女性。
RPOC 切除术的手术宫腔镜检查。手术当天采集血清 β-HCG 水平，≥5.0 mIU/mL 认为阳性。所有手术标本均由病理检查是否存在滋养层组织。
在纳入研究的 105 名女性中，81 例（77.1%）的手术病理显示存在滋养层组织，将其纳入数据分析。在这 81 例中，有 16 例（19.8%）β-HCG 水平阳性。与分娩后 RPOC 相比，流产（手术或药物）后 RPOC 的 β-HCG 水平阳性明显更高。此外，β-HCG 阳性组的 RPOC 质量中位数大于β-HCG 阴性组（分别为 29.1±9.5 mm 比 23.8±8.9 mm，p=0.004），且从终止妊娠到手术的间隔时间更短（分别为 4.8±1.7 周比 7.5±2.1 周，p<0.001）。在 2 例 RPOC 质量种植在既往剖宫产瘢痕上的病例中，发现相对较高的 β-HCG 水平（352 mIU/mL 和 3561 mIU/mL）。
β-HCG 水平对 RPOC 的术前诊断无帮助。
