title: Hysteroscopic management of retained products of conception: meta-analysis and literature review.
abstract: OBJECTIVE
  Hysteroscopic removal of retained products of conception (RPOC) may allow complete removal of RPOC and decreased rates of intrauterine adhesions (IUA) when compared to the traditional blind curettage. The aim of this meta-analysis is to examine the current evidence regarding the use of hysteroscopy for treatment of RPOC.
  
  
  METHODS
  A literature search was conducted in December 2012 using MEDLINE and ClinicalTrials. The study selection criteria were use of the standard hysteroscopic technique for removal of RPOC in 5 or more cases, in any study design. We reviewed 11 studies, of which 5 retrospective studies met the selection criteria (comprising 326 cases). The rates of incomplete RPOC removal, surgical complications, post-operative IUA and subsequent pregnancies were abstracted and weighted events rates using a fixed meta-analysis model were calculated.
  
  
  RESULTS
  Only one study compared the rates of IUA following hysteroscopy and curettage, precluding a meta-analysis comparison of the two techniques. There were no cases of incomplete RPOC removal. Three perioperative complications occurred (uterine perforation, infection, and vaginal bleeding). IUA on follow-up hysteroscopy were found in 4/96 women (weighted rate of 5.7%, 95% CI 2.4%, 13.0%). Of the 120 women desiring a subsequent pregnancy 91 conceived (weighted rate of 75.3%, 95% CI 66.7%, 82.3%).
  
  
  CONCLUSIONS
  The lack of traditional curettage comparison groups in most studies precludes the conclusion that hysteroscopy is superior to traditional curettage, but this procedure does appear to have low complication rates, low rates of IUA, and high rates of subsequent pregnancies.
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: noam_yossi@yahoo.com.
authors: Noam
authors: N
authors: Smorgick
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Oshri
authors: O
authors: Barel
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Noga
authors: N
authors: Fuchs
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Ido
authors: I
authors: Ben-Ami
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Moty
authors: M
authors: Pansky
authors: Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Zvi
authors: Z
authors: Vaknin
mesh_terms: D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D011247:Pregnancy; D000267:Tissue Adhesions / Q000517:prevention & control; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*
keywords: Hysteroscopy; Retained products of conception