Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception


  • Harish K. M. Department of Obstetrics and Gynecology, Malabar Medical College, Calicut, Kerala, India
  • Shwetha N. Department of Obstetrics and Gynecology, Malabar Medical College, Calicut, Kerala, India
  • Dipankar Debnath Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, Manipur, India



Hysteroscopy, Incomplete miscarriage, Pregnancy loss, Suction evacuation, Vacuum aspiration


Background: RPOC can occur due to spontaneous or induced abortion followed by incomplete or partial expulsion of product of conception. Suction evacuation is currently the standard surgical treatment, but operative hysteroscopy has the advantage over Suction evacuation allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications.

Methods: Comparative retrospective study of 80 patients who presented with RPOC during the period of 6 months. Hysteroscopy was done in 40 patients and Suction evacuation in remaining 40 patients. Data regarding anaesthesia required, mean time taken for procedure and post procedure hospital stay, complication due to the procedure and post-operative outcome were collected to compared,

Results: In hysteroscopy group none of patients required anaesthesia and even though mean time taken for the procedure is 2 minutes more in hysteroscopy group without statistical significant difference (P 0.672), the post procedure hospital stay is less compared to suction evacuation group. Complication due to procedure was seen in 5 (12.5%) patients in hysteroscopy group which is less compared to 13 (32.5%) patients in suction evacuation group. Mean number of days of pain requiring analgesia and Sick leave applied was also less in hysteroscopy group (1 day and 2 days respectively) group compared to suction evacuation group (9 days and 7 days respectively)

Conclusions: Lesser rates of intra and post-operative complications with hysteroscopy makes the procedure ‘safe’ to the patients and ‘effective’ as it ensures complete evacuation of the uterine cavity under direct vision and reduce the need for repeat procedure.


Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB Jr, Kamaya A. Physiologic, histologic, and imaging features of retained products of conception. Radiograph. 2013;33:781-96.

Van den Bosch T, Daemen A, Van Schoubroeck D, Pochet N, De Moor B. Occurrence and outcome of residual trophoblastic tissue: a prospective study. J Ultrasound Med. 2008;27(3):357-61.

Aseeja V. Management of retained products of conception with marked vascularity. J Turkish-German Gynecol Assoc. 2012;13:212-4.

Smorgick N, Barel O, Fuchs N, Ben-Ami I, Pansky M, Vaknin Z. Hysteroscopic management of retained products of conception: meta-analysis and literature review. Eur J Obstet Gynecol Reprod Biol. 2014;173:19e22

Friedler S, Margalioth EJ, Kafka I, Yaffe H. Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy: a prospective study. Hum Reprod. 1993;8(3):442-4.

Davis AR, Hendlish SK, Westhoff C, Frederick MM, Zhang J, Gilles JM, et al. Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. Am J Obstet Gynecol. 2007;196(1):31-e1.

Golan A, Dishi M, Shalev A, Keidar R, Ginath S, Sagiv R. Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem. J Minim Invasive Gynecol. 2011;18(1):100-3.

Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol. 2008;32:704-7.

Cohen SB, Kalter-Ferber A, Weisz BS, Zalel Y, Seidman DS, Mashiach, S, et al. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc. 2001;8:199-202.

Hamerlynck TW, Blikkendaal MD, Schoot BC, Hanstede MM, Jansen FW. An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol. 2013;20(6):796-802.






Original Research Articles