title: Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review.
abstract: OBJECTIVE
  To examine the long-term complications and reproductive outcomes after the management of retained products of conception (RPOC).
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Women suspected of RPOC who were subjected to medical therapy with misoprostol or surgical treatment.
  
  
  METHODS
  An electronic literature search was conducted in June 2015 using MEDLINE, EMBASE, and the Cochrane library. We included clinical trials in which women were consecutively included, independent of their symptoms.
  
  
  METHODS
  The prevalence of intrauterine adhesions (IUAs) and reproductive outcomes.
  
  
  RESULTS
  No studies reporting on IUAs or reproductive indicators after medical management with misoprostol were found. We included 10 cohort studies with poor to average methodological quality. Five cohort studies (n = 339) reported IUAs in 22.4% (95% confidence interval, 18.3%-27%) of women hysteroscopically evaluated. Significantly more IUAs were encountered after dilation and curettage (D&C) compared with after hysteroscopic resection (HR): 30% vs. 13%. Incomplete evacuation was encountered in, respectively, 29% and 1% of the D&C and HR cases. Similar conception, ongoing pregnancy, live-birth, and miscarriage rates were reported after D&C and HR in six cohort studies (n = 380), and there was a tendency toward earlier conception after HR. The reproductive outcomes were not reported in relation to IUAs.
  
  
  CONCLUSIONS
  HR may be a preferable surgical treatment in women suspected of RPOC; fewer IUAs and incomplete evacuations are encountered, while similar reproductive outcomes were reported compared with D&C. Confirmation of the observed effects is required, and trials evaluating medical treatment with misoprostol as well as expectant management are urgently needed.
authors.affiliation: Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, the Netherlands; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: hooker.a@zaansmc.nl.
authors.forename: Angelo B
authors.initials: AB
authors.lastname: Hooker
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Humeyra
authors.initials: H
authors.lastname: Aydin
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Hans A M
authors.initials: HA
authors.lastname: Brölmann
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D005260:Female; D005298:Fertility; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D016595:Misoprostol / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Retained products of conception; intrauterine adhesions; long-term complications; management; reproductive outcome