Retained products of conception following delivery by cesarean section: Is it a real entity?

OBJECTIVE: To describe our experience with diagnosis and hysteroscopic treatment of retained products of conception (RPOC) following cesarean delivery (CD). STUDY DESIGN: A retrospective study of all women who underwent hysteroscopy for treatment of suspected RPOC following CD. Their obstetrical history, clinical presentation, ultrasound and hysteroscopic findings, and pathology reports were re-viewed and analyzed. RESULTS: A total of 24 cases were identified out of 11,170 CDs during the study period (0.21%). In 17 (70.8%) women, no difficul-ty was encountered in the removal of the placenta during CD, while in the remaining 7 (29.2%) the surgeon identified an adherent placenta which could not be separated easily. On hysteroscopy, complete RPOC removal on the first hysteroscopic procedure was possible in 21/24 (87.5%) cases, while 3 women underwent 2 hysteroscopic procedures. No intraoperative complications occurred. On follow-up office hysteroscopy a normal uterine cavity was observed in 14/18 (77.7%), minimal adhesions were seen in 3 (16.7%) cases, and there were severe adhesions in 1 case (5.6%). CONCLUSION: Although rare, RPOC following CD may occur. Treatment by hysteroscopy is feasible and has the advantage of low rates of complications and postoperative intrauterine adhesions.