経頸管摘除術を施行したRetained products of conception 18症例の検討

抄録

Objective: Retained products of conception (RPOC) is defined as a condition of persistent fetal or placental tissue within the uterine cavity after abortion or delivery. Its chief clinical complications include irregular bleeding and excessive postpartum bleeding. In cases involving infertility treatment, the treatment must be interrupted until the lesions disappear. No standard treatment protocol has been established; transcervical resection (TCR) is the basic treatment strategy at our hospital. In this study, we retrospectively reviewed the outcomes of RPOC patients who underwent TCR at our hospital, aiming to evaluate its efficacy.

Methods: The medical records of patients who underwent TCR with a confirmed diagnosis of RPOC from July 2013 to June 2023 were retrospectively reviewed.

Results: This study included 18 patients, with a median age of 37 years; notably, 12 (66.7%) were concurrently undergoing fertility treatment. Pregnancies preceding RPOC included four (22.2%) complete abortions, 13 (72.2%) missed abortions, and one (5.6%) vaginal delivery case. Massive bleeding was observed in two patients (11.1%), and uterine artery embolization was performed in one patient (5.6%). Of the 17 patients evaluated by ultrasound doppler prior to TCR, eight (47.1%) exhibited blood flow to the mass, concomitant with pronounced symptoms of genital bleeding. The intraoperative blood loss was minimal, obviating the need for transfusions. Four patients achieved pregnancies postoperatively.

Conclusion: TCR for RPOC emerges as an effective lesion removal technique, irrespective of the timing of intervention, provided that genital bleeding is effectively managed before the TCR procedure.