P02.06: Ultrasound based criteria for the selection of women for hysteroscopic removal of retained products rather than conventional suction curettage

Objectives: Conventional evacuation of retained products of conception (RPOC) is a blind technique which may not remove focal RPOC and is associated with perforation and adhesion risks. Ultrasound (USS) guided evacuation of retained products of conception (ERPC) is a commonly used alternative but we hypothesised that for focal retained tissue following miscarriage, termination of pregnancy (TOP) or delivery hysteroscopic removal of tissue under direct visualisation was an effective and safe alternative which allows intraoperative confirmation of an empty uterus. Methods: For 15 months women with small well-defined intrauterine focal mixed hyperechogenic tissue, with or without vascularity, following miscarriage, TOP or delivery were selected for hysteroscopic management. Under general anaesthesia an 8 mm saline resectoscope without an active electrode was used. Operative findings, procedures, complications, repeat USS and histology are reported. Results: 15 patients were identified retrospectively. Initial presentation was miscarriage (6), TOP (3) and post delivery (6). In 4/15 findings followed blind ERPC. Mean AP diameter of tissue was 17.3 mm (range 4.3–29 mm). In 15/15 (100%) USS findings were confirmed by direct visualisation of frond-like pale tissue or an isolated nodule at hysteroscopy. 1/15 (7%) was complicated by uterine perforation. In 15/15 (100%) blood loss was minimal. Histology confirmed RPOC in 12/15 (80%), implantation site reaction in 2/15 (13%) and chronic endometritis in 1/15 (7%). 7/7 who returned for follow up at 8/52 had an empty uterine cavity confirmed. Conclusions: The ultrasound criteria perform well in identifying focal RPOC. The 7% negative histology may be due to false positive USS or sample collection problems. We propose prospective comparison of USS guided ERPC with hysteroscopy.