Retained products of conception (RPOCs) describe placental/fetal tissue that remains in the uterus after a miscarriage, planned pregnancy termination, or delivery, and complicates about 1% of pregnancies. Management consisted of dilation and curettage (D&C), which may expose the uterus to trauma and sequelae of infection, intrauterine adhesions (IUAs), and subsequent infertility. D&C is a blind procedure that is associated with a 30% incidence of IUAs. Because of this concern, many physicians choose to treat RPOCs with hysteroscopy, where the tissue can be removed under direct visualization. We have recently published the largest cohort study examining reproductive outcomes after hysteroscopic management of RPOCs. While reviewing pathology reports, we noted that some commented on the presence of chronic endometritis (CEM), while others did not comment on its presence or absence. At this time, it is not known how often CEM is found in cases of RPOCs. This is important because not all physicians treat patients with a course of antibiotics following this procedure, which is the treatment of choice for CEM. Left untreated, CEM has been associated with implantation failure or early pregnancy loss. Because hysteroscopic resection of RPOCs is a commonly performed procedure at Northwestern, we are in a unique position to change how this condition is treated.
|Effective start/end date||9/1/18 → 8/31/21|
- Northwestern Memorial Hospital (NMH Agmt #15 Exhibit B.15)
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