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Hysteroscopy may be the method of choice for management of residual trophoblastic tissue
S B Cohen1, A Kalter-Ferber, B S Weisz
1Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel.
Study Objective:
To assess the efficacy of and reproductive outcome after selective curettage of residual trophoblastic tissue directed by hysteroscopy compared with conventional, nonselective, blind curettage.
Design:
Retrospective analysis (Canadian Task Force classification II-1).
Setting:
Tertiary care medical center.
Patients:
Seventy patients after curettage or delivery, with clinical and ultrasonographic signs of suspected residual trophoblastic tissue.
Measurements And Main Results:
Twenty-four women underwent traditional curettage and 46 underwent hysteroscopic selective curettage. Five (20.8%) patients who underwent traditional curettage later required operative hysteroscopy due to persistent residual tissue. None of those who underwent hysteroscopic selective curettage needed a second operation. No patient in either group experienced anesthetic complications, perforation of the uterus, fluid overload, or other surgical complication. Reproductive outcome was similar in both groups, with tendency to conceive earlier in the hysteroscopy group, but no difference in overall pregnancy rates.
Conclusion:
Operative hysteroscopy for selective curettage of residual trophoblastic tissue should be considered an alternative to nonselective, blind curettage.