Managing residual trophoblastic tissue: Hysteroscopy for directing curettage

OBJECTIVE: To describe our experience with selective removal of residual intrauterine trophoblastic tissue via hysteroscopy. METHODS: This is a descriptive report. Eighteen patients, 16 postabortion and 2 postpartum, underwent a hysteroscopic procedure for removal of residual trophoblastic tissue causing continuous bleeding. At hysteroscopy, a cutting loop was used as a curette for selective removal of the adherent residual tissue, while interference with the rest of the endometrial surface was avoided. RESULTS: Complete removal of the suspected residual tissue was achieved in all patients. Histology confirmed the curettings as trophoblastic remnants. No complications were reported during or immediately after the procedure. The median operative time was 10 minutes (range, 8-20). In all cases the bleeding stopped shortly after the procedure. In each patient, postoperative ultrasonography revealed a uterine cavity free of residual tissue. Five of the patients underwent second-look hysteroscopy several weeks later, and no signs of further residual tissue were observed. CONCLUSION: Selective curettage of residual trophoblastic tissue directed by hysteroscopy is an easy and short procedure and might be preferable to conventional, nonselective, blind curettage.