Real-world Research Of The Appropriate Timing Of Surgery For Retained Products Of Conception

Objective: To investigate the appropriate operation timing and protective effect on the endometrium of retained products of conception(RPOC)in the uterine cavity.Methods:(1)A total of 200 patients who underwent hysteroscopic removal of pregnancy material in the Third Xiangya Hospital of Central South University from December 2015 to July 2021 were retrospectively included and divided into control group(surgery within1 month after termination of pregnancy,63 cases)and research group(137 cases of expectant treatment for more than 1 month after termination of pregnancy before surgery).(2)From August 2021 to January 2022,patients with RPOC who were admitted to the outpatient and emergency department of our hospital were prospectively enrolled.Those who meet the conditions of the preset timing of surgery are directly admitted to the hospital for surgery,and those who do not meet the conditions are treated with expectant treatment first.During the follow-up period,if the pregnant material is excreted and the residual diameter <0.5 cm,it is continued to be observed until the next menstrual period is cleaned and the ultrasound is checked(Conservative treatment group).When the gestation persists and the residual tissue diameter >0.5 cm,and the bloodβ-HCG is less than 50 m IU/m L or the distance from the internal cervical orifice to the fundus ≤6cm,the patients were admitted for surgery(Preset operation group).If vaginal bleeding exceeded menstrual flow or had signs of infection,patients were admitted to hospital for intervention in advance(Advance operation group).The general data of patients,residual pregnancy information,surgical conditions(uterine depth,operation time,intraoperative blood loss,visual field clarity rate,primary clearance rate,secondary operation rate),complications(decreased postoperative menstrual flow,new intrauterine adhesions)and re-pregnancy were compared between groups.Results:(1)Retrospective: The preoperative blood β-HCG in the research group was significantly lower than that in the control group(1.29 vs 218.00 m IU/m L,P<0.05);there was no difference in preoperative pregnancy and uterine diameter between the two groups(P>0.05),but The gestational week at the termination of pregnancy,the gravid and the diameter of the uterus at the first visit in the research group were significantly higher than those in the control group(P<0.05).There was no significant difference in the surgical conditions,re-pregnancy rate and live birth rate between the two groups(P>0.05),but the spontaneous abortion rate in the research group was significantly lower than that in the control group(1.89% vs 14.81%)(P<0.05).The incidence of postoperative menstrual reduction in the research group was significantly lower than that in the control group(10.22% vs33.33%,P<0.05).The rate of new adhesions diagnosed by hysteroscopy in the research group was lower than that in the control group(5.38% vs14.29%,P=0.0620).Surgery within 1 month after termination of pregnancy(OR: 4.210,95%CI: 1.865-9.805)and preoperative larger pregnancy diameter(OR:1.042,95%CI: 1.006-1.082)were risk factors for decreased menstrual flow or new adhesions after surgery(P<0.05);special type of RPOC(incision site or combined implantation)(OR: 3.721,95%CI:1.118-14.710)was the risk factor for needing secondary surgery(P<0.05).(2)Prospective: A total of 61 patients were included,and 31patients(50.82%)did not need surgery after expectant treatment.There were 23 patients who reached the pre-set conditions for surgery,and 7patients who underwent early intervention.Among them,3 patients had decreased menstrual flow after surgery and were diagnosed as intrauterine adhesions(4.92%).Special type RPOC(OR: 14.179,95%CI: 1.308-193.611)was a risk factor for surgical treatment after expectant treatment.RPOC with rich blood flow(OR: 11.748,95%CI: 1.350-102.236)was a risk factor that required early intervention during expectant treatment.Conclusion: Compared with surgery within 1 month after termination of pregnancy,expectant treatment can allow some patients to avoid surgery,reduce the incidence of postoperative menstrual loss,and possibly reduce the incidence of postoperative IUAs.