Reproductive Outcomes in Patients with a History of Retained Products of Conception after Delivery versus Abortion

Introduction: RPOC are associated with the formation of intrauterine adhesions and subsequent infertility.

Aim: To compare reproductive outcomes in patients with a history of retained products of conception after delivery and abortion.

Materials & Methods: This is a cohort of operative hysteroscopies performed between 2011-2015 for suspected RPOC, during which confirmed trophoblastic tissue was obtained. Variables were compared between cases following delivery (n=85), and following abortion (n=96).

Results: A history of infertility following hysteroscopy, defined as at least one year of failure to conceive, was noted in 11 patients (11.8%) in the post abortion group, four of whom were receiving assisted reproductive treatment, as compared to two patients (2.3%) in the post-delivery group, one of whom was receiving assisted reproductive treatments (p=0.01). None of the cases were attributed to mechanical female factor. A similar rate of patients in both groups experienced an abortion since their hysteroscopy. In the post-delivery group – 34 patients delivered following hysteroscopy (40.0%), while in the post-abortion group 37 delivered (39.7%). Deliveries in the post-delivery group were notable for a higher rate of abnormal placentation – 30.5% - including low lying placenta and placenta accreta. A significant rate of vaginal deliveries in both groups entailed manual removal of the placenta or manual exploration of the uterine cavity (23.5% and 10.5%, p=0.20).

Conclusion: In the assessment of infertility patients, a history of past RPOC following delivery or abortion entails a similar prognosis. During pregnancy follow up – cases of RPOC following delivery necessitate careful attention to placentation.