Operative hysteroscopy
Abortive and Placental Residues
This pathology consists of the presence of abortive material or placenta fragments inside the uterus after an abortion curettage or post-partum haemorrhage, after delivery without apparent complications, after a termination of pregnancy.
It is very important to diagnose it in time with an ultrasound and especially with a diagnostic hysteroscopy because, if neglected, it can lead to infection, the formation of adhesions in the uterus with loss of menstruation and fertility.
Symptoms:
- Persistence of abnormal uterine bleeding after an abortion or a spontaneous or caesarean section delivery
- Presence of abdominal pain and fever
- Amenorrhoea or hypomenorrhoea (absent or scanty menses) after curettage
Diagnosis
- Transvaginal control ultrasound
- Diagnostic hysteroscopy
The ultrasound scan should be done as soon as the above symptoms appear but the diagnosis of certainty is made with a diagnostic hysteroscopy. hysteroscopy is more delicate in cases like these because the recently pregnant uterus is more delicate. the walls are softer and the risk of perforation is greater.
Surgical technique (operative hysteroscopy)
- Careful attention must be paid to the location and extent of the residue
- Remove the soft, exuberant part of the residue when cold if possible
- Use equatorial thermal loops that have a lower risk of perforation
- Using cold loops to enucleate the base of the residue that often infiltrates the uterine wall (chorion or placenta accreta)
Cautions and Precautions:
- Avoid long waits by waiting for spontaneous expulsion of the residue and having repeated ultrasound scans
- Perform a post-partum haemorrhage curettage as soon as possible if a placenta fragment is suspected inside the uterus
- Use caution when introducing the hysteroscope into the uterus
- Absolutely avoid repeated curettage (each curettage increases the risk of intrauterine adhesions forming)
- Abolish all cavity examinations
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