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Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review.
Fertil Steril. 2016 Jan; 105(1):156-64.e1-2.FS

Abstract

OBJECTIVE

To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC).

DESIGN

Systematic review.

SETTING

Not applicable.

PATIENT(S)

Women suspected of RPOC who were subjected to medical therapy with misoprostol or surgical treatment.

INTERVENTION(S)

An electronic literature search was conducted in June 2015 using MEDLINE, EMBASE, and the Cochrane library. We included clinical trials in which women were consecutively included, independent of their symptoms.

MAIN OUTCOME MEASURE(S)

The prevalence of intrauterine adhesions (IUAs) and reproductive outcomes.

RESULT(S)

No studies reporting on IUAs or reproductive indicators after medical management with misoprostol were found. We included 10 cohort studies with poor to average methodological quality. Five cohort studies (n = 339) reported IUAs in 22.4% (95% confidence interval, 18.3%-27%) of women hysteroscopically evaluated. Significantly more IUAs were encountered after dilation and curettage (D&C) compared with after hysteroscopic resection (HR): 30% vs. 13%. Incomplete evacuation was encountered in, respectively, 29% and 1% of the D&C and HR cases. Similar conception, ongoing pregnancy, live-birth, and miscarriage rates were reported after D&C and HR in six cohort studies (n = 380), and there was a tendency toward earlier conception after HR. The reproductive outcomes were not reported in relation to IUAs.

CONCLUSION(S)

HR may be a preferable surgical treatment in women suspected of RPOC; fewer IUAs and incomplete evacuations are encountered, while similar reproductive outcomes were reported compared with D&C. Confirmation of the observed effects is required, and trials evaluating medical treatment with misoprostol as well as expectant management are urgently needed.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, the Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: hooker.a@zaansmc.nl.Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

26453977

Citation

Hooker, Angelo B., et al. "Long-term Complications and Reproductive Outcome After the Management of Retained Products of Conception: a Systematic Review." Fertility and Sterility, vol. 105, no. 1, 2016, pp. 156-64.e1-2.
Hooker AB, Aydin H, Brölmann HA, et al. Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review. Fertil Steril. 2016;105(1):156-64.e1-2.
Hooker, A. B., Aydin, H., Brölmann, H. A., & Huirne, J. A. (2016). Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review. Fertility and Sterility, 105(1), 156-e1-2. https://doi.org/10.1016/j.fertnstert.2015.09.021
Hooker AB, et al. Long-term Complications and Reproductive Outcome After the Management of Retained Products of Conception: a Systematic Review. Fertil Steril. 2016;105(1):156-64.e1-2. PubMed PMID: 26453977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review. AU - Hooker,Angelo B, AU - Aydin,Humeyra, AU - Brölmann,Hans A M, AU - Huirne,Judith A F, Y1 - 2015/10/09/ PY - 2015/06/08/received PY - 2015/09/15/revised PY - 2015/09/15/accepted PY - 2015/10/11/entrez PY - 2015/10/11/pubmed PY - 2016/5/12/medline KW - Retained products of conception KW - intrauterine adhesions KW - long-term complications KW - management KW - reproductive outcome SP - 156-64.e1-2 JF - Fertility and sterility JO - Fertil. Steril. VL - 105 IS - 1 N2 - OBJECTIVE: To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC). DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): Women suspected of RPOC who were subjected to medical therapy with misoprostol or surgical treatment. INTERVENTION(S): An electronic literature search was conducted in June 2015 using MEDLINE, EMBASE, and the Cochrane library. We included clinical trials in which women were consecutively included, independent of their symptoms. MAIN OUTCOME MEASURE(S): The prevalence of intrauterine adhesions (IUAs) and reproductive outcomes. RESULT(S): No studies reporting on IUAs or reproductive indicators after medical management with misoprostol were found. We included 10 cohort studies with poor to average methodological quality. Five cohort studies (n = 339) reported IUAs in 22.4% (95% confidence interval, 18.3%-27%) of women hysteroscopically evaluated. Significantly more IUAs were encountered after dilation and curettage (D&C) compared with after hysteroscopic resection (HR): 30% vs. 13%. Incomplete evacuation was encountered in, respectively, 29% and 1% of the D&C and HR cases. Similar conception, ongoing pregnancy, live-birth, and miscarriage rates were reported after D&C and HR in six cohort studies (n = 380), and there was a tendency toward earlier conception after HR. The reproductive outcomes were not reported in relation to IUAs. CONCLUSION(S): HR may be a preferable surgical treatment in women suspected of RPOC; fewer IUAs and incomplete evacuations are encountered, while similar reproductive outcomes were reported compared with D&C. Confirmation of the observed effects is required, and trials evaluating medical treatment with misoprostol as well as expectant management are urgently needed. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/26453977/Long_term_complications_and_reproductive_outcome_after_the_management_of_retained_products_of_conception:_a_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(15)01938-X DB - PRIME DP - Unbound Medicine ER -