A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception

Objective To compare the reproductive outcome of women who underwent blind dilatation and curettage (D&C) with those who underwent hysteroscopic resection of pathologically confirmed retained products of conception (RPOC). Methods Medical records of women who underwent either D&C or hysteroscopic resection of RPOC at Assaf Harofeh Medical Center, Israel, between 2000 and 2010 were retrospectively reviewed. Results A total of 177 women with pathologically confirmed RPOC underwent either D&C (n = 94, 53.1%) or hysteroscopy (n = 83, 46.9%). Mean time to conception was significantly shorter after hysteroscopy than after D&C (7.4 ± 7 vs 12.9 ± 16.8 months, P = 0.037). Rate of occurrence of a newly diagnosed infertility problem was significantly higher following D&C than hysteroscopy (23 [24.5%] vs 10 [12.0%]; P = 0.034). Etiology of the new problem was mechanical, including tubal occlusion and intrauterine adhesions. Logistic regression comparing both methods revealed that hysteroscopic resection was associated with a significant reduction in the occurrence of a new infertility problem compared with D&C (OR 0.42; 95% CI, 0.18-0.96, P = 0.04). Conclusion Hysteroscopic removal of RPOC is associated with a shorter mean time to further conception and a lower rate of occurrence of newly diagnosed infertility problems than D&C.