Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 669–674 | Cite as

Two-step hysteroscopy for management of morbidly adherent retained products of conception

  • Noam SmorgickEmail author
  • Ira Rabinovitch
  • Orna Levinsohn-Tavor
  • Ron Maymon
  • Zvi Vaknin
  • Moty Pansky
General Gynecology



Retained products of conception (RPOC) may occur as the result of a morbidly adherent placenta. In these cases, the hysteroscopic removal of RPOC may be technically challenging, and may require more than one hysteroscopic procedure. We sought to compare the clinical, surgical, and postoperative characteristics of cases managed by either a one-step hysteroscopy procedure or a two-step hysteroscopy approach.


A retrospective review of all RPOC cases managed by hysteroscopy from 1/2013 to 3/2018. We included cases of RPOC occurring following delivery and medical or surgical pregnancy terminations. The rates of postoperative intrauterine adhesions were assessed by office hysteroscopy.


A two-step procedure was required in 11 (3.9%) of the 358 women who underwent hysteroscopy for removal of RPOC during the study period. Comparison between the two-step and the one-step procedure groups revealed that the women in the two-step group were significantly older and the mean RPOC size was significantly larger (35.5 ± 4.1 years versus 30.7 ± 5.9 years, respectively, p = 0.01, and 38.6 ± 9.8 mm versus 22.3 ± 7.5 mm, p < 0.001, respectively). While the rates of intraoperative complications were similar between groups, readmission for postoperative fever was more common in the two-step group (18.2% versus 2.0%, respectively, p = 0.03). Postoperative intrauterine adhesions were diagnosed in 20.0% and 5.2%, respectively (p = 0.05).


The two-step hysteroscopic approach enabled the complete removal of larger RPOC masses without the use of uterine curettage. The women who underwent the two-step procedure, however, were at increased risk for postoperative fever and postoperative intrauterine adhesions.


Retained products of conception Residual trophoblastic tissue Placental remnants Hysteroscopy 


Author contributions

We confirm that each author has fulfilled the conditions of having made substantial contributions to the concept and design, analysis, and interpretation of data and drafting and/or revisions of the manuscript. None of the authors have any disclosures.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Assaf Harofeh Medical CenterAffiliated With Tel-Aviv University, Sackler School of MedicineTel AvivIsrael
  2. 2.Minimally Invasive Gynecologic Surgery, Department of Obstetrics and GynecologyAssaf Harofeh Medical CenterBeer YaakovIsrael

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