Articles
Ultrasound-guided hysteroscopy (UGHys) for the management of high-risk retained products of conception: a retrospective case series
Milo Giani, Elisa Wu, Ernesto Gallucci, Massimiliano Fambrini, Felice Petraglia, Maria Elisabetta Coccia
, xx-xx
ABSTRACT
Objective. Retained Products of Conception (RPOC) can be highly vascularized, increasing the risk of severe or life-threatening hemorrhage during surgery. Identification of high-risk cases is crucial to minimize complications. The aim of this study was to assess single-step Ultrasound-Guided Hysteroscopy (UGHys), a minimally invasive technique combining ultrasound and hysteroscopic guidance for highly vascularized RPOC.
Materials and Methods. We conducted a retrospective study at Careggi Hospital in 2024 on the obstetric population hospitalized for delivery or miscarriage to identify cases of RPOC. Transvaginal ultrasound (TVUS) with Doppler, performed according to International Endometrial Tumor Analysis (IETA) criteria, was used to stratify patients by bleeding risk. Low-risk cases were managed conservatively with TVUS follow-up, whereas high-risk cases underwent UGHys removal. The primary outcome was procedural success, defined as complete removal without bleeding.
Results. Among 3944 screened patients, 62 surgical RPOC were included (1,57%), of whom 6 (9.67%) were classified as high-risk. Mean gestational age at termination was higher in the high-risk group (9.67 ± 2.84 vs. 6.94 ± 1.79 weeks; p= 0.034), a difference that was also clinically relevant. All high-risk cases were successfully treated with UGHys. No intra- or postoperative complications occurred, all patients were discharged the same day, and no repeat hysteroscopy was required.
Conclusions. UGHys appears to be a safe and effective single-step technique for managing highly vascularized RPOC, achieving complete removal avoiding complications and preserving fertility. RPOC following pregnancies beyond nine weeks or with prolonged persistence are more likely to show high vascularity and therefore warrant careful assessment.
Key words
Retained products of conception; residual trophoblastic tissue; operative hysteroscopy; enhanced myometrial vascularity; doppler ultrasound.
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