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Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage.
J Minim Invasive Gynecol. 2011 Nov-Dec; 18(6):774-8.JM

Abstract

STUDY OBJECTIVE

The aim of this study was to estimate the rate of intrauterine adhesions and subsequent pregnancy outcome in patients with residual trophoblastic tissue treated with hysteroscopic resection versus ultrasound-guided dilation and evacuation (D&E).

DESIGN

Cohort study from 2 centers (Canadian Task Force classification II-2).

SETTING

Two surgical teams at the University of Duesseldorf Medical Center and the PAN Clinic in Cologne, Germany.

PATIENTS

Women with residual trophoblastic tissue after first- or second-trimester miscarriage or term delivery.

INTERVENTION

Two techniques were used for the removal of residual trophoblastic tissue: ultrasound-guided evacuation with a curette (D&E) and hysteroscopic resection of trophoblastic tissue (HR).

MEASUREMENTS AND MAIN RESULTS

We evaluated 95 patients who underwent secondary intervention for residual trophoblastic disease. A total of 42 patients underwent dilation of the cervix and ultrasound-guided curettage. In a second series of 53 patients, a resectoscope fitted with a 4-mm cutting loop was used for the removal of residual trophoblastic tissue used without application of current. Three months after the intervention, second-look office hysteroscopy was performed. Differences between both treatment groups were statistically significant. After HR, mild intrauterine adhesions were found in 2 patients (4.2%). After D&E, 12 patients (30.8%) presented with intrauterine adhesions (mild intrauterine adhesions: n = 7 [17.9%]; single dense adhesions: n = 3 [7.7%]; and extensive endometrial fibrosis n = 1 [2.6%]). Eighty-two patients wanted to become pregnant. Conception rate of all patients examined was 68.8% (HR) and 59.9% (D&E) (p < .05). In patients younger than 35 years of age who underwent HR, the pregnancy rate was significantly (p < .05) increased compared with patients who underwent D&E (78.1% vs 66.6%). In addition, patients from the HR group demonstrated a significantly (p < .05) shorter time to conception (11.5 month vs 14.5 month).

CONCLUSION

The results of this study indicate that selective HR of residual trophoblastic tissue significantly reduces the incidence of intrauterine adhesions and increases pregnancy rates.

Authors+Show Affiliations

Department of Gynecology and Obstetrics, University of Duesseldorf Medical Center, Duesseldorf, Germany. daniel.rein@hohenlind.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22024264

Citation

Rein, Daniel T., et al. "Hysteroscopic Management of Residual Trophoblastic Tissue Is Superior to Ultrasound-guided Curettage." Journal of Minimally Invasive Gynecology, vol. 18, no. 6, 2011, pp. 774-8.
Rein DT, Schmidt T, Hess AP, et al. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol. 2011;18(6):774-8.
Rein, D. T., Schmidt, T., Hess, A. P., Volkmer, A., Schöndorf, T., & Breidenbach, M. (2011). Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. Journal of Minimally Invasive Gynecology, 18(6), 774-8. https://doi.org/10.1016/j.jmig.2011.08.003
Rein DT, et al. Hysteroscopic Management of Residual Trophoblastic Tissue Is Superior to Ultrasound-guided Curettage. J Minim Invasive Gynecol. 2011 Nov-Dec;18(6):774-8. PubMed PMID: 22024264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. AU - Rein,Daniel T, AU - Schmidt,Torsten, AU - Hess,Alexandra P, AU - Volkmer,Anne, AU - Schöndorf,Thomas, AU - Breidenbach,Martina, PY - 2011/05/31/received PY - 2011/08/01/revised PY - 2011/08/03/accepted PY - 2011/10/26/entrez PY - 2011/10/26/pubmed PY - 2012/3/1/medline SP - 774 EP - 8 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 18 IS - 6 N2 - STUDY OBJECTIVE: The aim of this study was to estimate the rate of intrauterine adhesions and subsequent pregnancy outcome in patients with residual trophoblastic tissue treated with hysteroscopic resection versus ultrasound-guided dilation and evacuation (D&E). DESIGN: Cohort study from 2 centers (Canadian Task Force classification II-2). SETTING: Two surgical teams at the University of Duesseldorf Medical Center and the PAN Clinic in Cologne, Germany. PATIENTS: Women with residual trophoblastic tissue after first- or second-trimester miscarriage or term delivery. INTERVENTION: Two techniques were used for the removal of residual trophoblastic tissue: ultrasound-guided evacuation with a curette (D&E) and hysteroscopic resection of trophoblastic tissue (HR). MEASUREMENTS AND MAIN RESULTS: We evaluated 95 patients who underwent secondary intervention for residual trophoblastic disease. A total of 42 patients underwent dilation of the cervix and ultrasound-guided curettage. In a second series of 53 patients, a resectoscope fitted with a 4-mm cutting loop was used for the removal of residual trophoblastic tissue used without application of current. Three months after the intervention, second-look office hysteroscopy was performed. Differences between both treatment groups were statistically significant. After HR, mild intrauterine adhesions were found in 2 patients (4.2%). After D&E, 12 patients (30.8%) presented with intrauterine adhesions (mild intrauterine adhesions: n = 7 [17.9%]; single dense adhesions: n = 3 [7.7%]; and extensive endometrial fibrosis n = 1 [2.6%]). Eighty-two patients wanted to become pregnant. Conception rate of all patients examined was 68.8% (HR) and 59.9% (D&E) (p < .05). In patients younger than 35 years of age who underwent HR, the pregnancy rate was significantly (p < .05) increased compared with patients who underwent D&E (78.1% vs 66.6%). In addition, patients from the HR group demonstrated a significantly (p < .05) shorter time to conception (11.5 month vs 14.5 month). CONCLUSION: The results of this study indicate that selective HR of residual trophoblastic tissue significantly reduces the incidence of intrauterine adhesions and increases pregnancy rates. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/22024264/Hysteroscopic_management_of_residual_trophoblastic_tissue_is_superior_to_ultrasound_guided_curettage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(11)00431-6 DB - PRIME DP - Unbound Medicine ER -