Objective: To assess the prevalence and risk factors for Intra-Uterine Adhesions (IUA) following hysteroscopic treatment of retained products of conception (RPOC).
Design: Retrospective cohort study.
Setting: Gynecologic endoscopy unit.
Patients: 167 women referred to our institution from 2009 to 2013.
Interventions: Operative hysteroscopy for treatment of RPOC and office hysteroscopy follow up to assess for IUA.
Main Outcome Measures: We investigated demographic characteristics, obstetrics parameters and surgical variables to evaluate which factors could be associated with IUA formation.
Results: Out of 167 women treated for RPOC, 84 (50.3%) had undergone a follow-up hysteroscopic evaluation after the operative hysteroscopy and were included in the study. IUA were found in 16 (19.0%) cases, of which only 3 (3.6%) were severe adhesions. Multivariate analysis showed that the presence of IUA was associated with RPOC following cesarean section (5/10 [50.5%] developed IUA versus 7/49 [14.3%] following vaginal delivery, p<0.05). IUA were also found in 4/23 (17.4%) women undergoing hysteroscopy for RPOC following abortion. The patients’ age, gravidity, parity and the interval between the index pregnancy and treatment for RPOC were not associated with post-operative IUA.
Conclusion: Hysteroscopic treatment for RPOC had a 3.6% incidence of severe intrauterine adhesions formation in this descriptive series. Women with RPOC occurring after delivery by cesarean section are particularly at risk for development of IUA.