Outpatient Operative Hysteroscopy for Retained Products of Conception

Study Objective To determine the feasibility, time taken, completeness of removal of the retained products conception (RPOC) by outpatient hysteroscopy (OH) Design Prospective Study with a follow up of 4 weeks. Setting Private Hospital Based Outpatient Setting. Ethical committee approval was obtained Patients or Participants All women treated by OH for RPOC Type 0,1 & 2, following first trimester abortion/ termination of pregnancy with Tab mifepristone 200 mg - Tab misoprostol 800 ug protocol from March 2017 to January 2020. A total of 44 women were included, and informed written consent was obtained. Interventions OH was performed using a 5 mm continuous flow office hysteroscope (Bettocchi Office Hysteroscope size 5, Karl Storz, Tuttlingen, Germany) with a 2.9 mm rod lens optical system, without the use of premedication or anesthesia before, during or after the procedure. Intrauterine pressure was maintained at 60 mmHg using an electronic pump. RPOC was excised from its base with a 5 Fr semi rigid scissors and removed from the uterine cavity with a semi rigid grasper. A vascular pedicle of Type 2 RPOC was cauterized using a bipolar electrode connected to a electrosurgical unit by a bipolar high frequency cord. Measurements and Main Results The maximal size of RPOC removed was 2.5 cm. Mean size of the RPOC treated was 1.8 cm. Mean time taken for removal of RPOC was 22 minutes. Complete removal of RPOC was achieved in a single setting, and none of these women required a second procedure. Mean VAS(visual analogue score of pain) score was Conclusion Outpatient hysteroscopy with complete removal of retained products is feasible without any form of anesthesia and negligible complications. Preoperative assessment of the size and type of RPOC by a transvaginal doppler ultrasound adds to the success of this technique.