title: Immediate and long-term complications of delayed surgical management in the postpartum period: a retrospective analysis.
abstract: OBJECTIVE
  To assess the rate of complications of surgical interventions delayed more than 24 h after delivery in women suspected of placental remnants.
  
  
  METHODS
  A retrospective review was performed to analyse complications of delayed surgical interventions. Women were identified from the operation database and their medical records were reviewed to determine the rate of immediate and long-term complications, including reproductive outcome.
  
  
  RESULTS
  A total of 127 women were evaluated. The median interval between delivery and surgery was 42 days. Immediate complications were registered in 22.0% and re-interventions in 16.5%. Placental remnants were histologically confirmed in 63.8%. Intrauterine adhesions (IUAs), only of the severe type, were recorded in 20.5%, although a minority of women was hysteroscopically revised. The difference between women treated by dilatation and curettage (D&C) and hysteroscopy was not statistically significant. Similar reproductive outcomes were encountered in women treated by D&C and hysteroscopy and in women with and without IUAs, although the samples were small.
  
  
  CONCLUSIONS
  Identification of placental remnants remains difficult while delayed interventions are associated with significant immediate and long-term complications. The impact on reproductive performance remains unclear. Further research is necessary to examine treatment options in relation to complications and reproductive outcome.
authors.affiliation: a Department of Obstetrics and Gynaecology , Zaans Medisch Centrum (ZMC) , Zaandam , The Netherlands .|b Department of Obstetrics and Gynaecology , Sint LucasAndreas Hospital (SLAZ) , Amsterdam , The Netherlands , and.|c Department of Obstetrics and Gynaecology , Free University Medical Centre , Amsterdam , The Netherlands.
authors.forename: Angelo B
authors.initials: AB
authors.lastname: Hooker
authors.affiliation: b Department of Obstetrics and Gynaecology , Sint LucasAndreas Hospital (SLAZ) , Amsterdam , The Netherlands , and.
authors.forename: Linda T
authors.initials: LT
authors.lastname: Muller
authors.affiliation: b Department of Obstetrics and Gynaecology , Sint LucasAndreas Hospital (SLAZ) , Amsterdam , The Netherlands , and.
authors.forename: Emma
authors.initials: E
authors.lastname: Paternotte
authors.affiliation: b Department of Obstetrics and Gynaecology , Sint LucasAndreas Hospital (SLAZ) , Amsterdam , The Netherlands , and.
authors.forename: Andreas L
authors.initials: AL
authors.lastname: Thurkow
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D018457:Placenta, Retained / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Adhesions; Asherman syndrome; placental remnant; reproductive outcome; surgery