Our aim was to minimize thermal damage to the endometrium in order to reduce the risk of formation of intrauterine adhesions, perforation, and bleeding. During the procedure, we minimized the use of electrosurgery, and under transabdominal ultrasound guidance, remnants were successfully removed as close as the uterine serosal border. In order to separate and remove gently and selectively the placental remnant from the underlying endometrium, we used the loop of the bipolar resectoscope as a curette performing cold dissection. Hysteroscopy revealed a mass which grossly measured 1.5 × 1.5 × 2 cm. The woman was in gynecologic position, and the procedure was carried out after cervical dilation using Hegar’s candles.
The procedure was performed under general anesthesia using a 26-F resectoscope (Karl Storz, Tuttlingen, Germany) fitted with a bipolar 4-mm cutting loop. Hysteroscopic removal of the retained tissue under ultrasound guidance was decided. Serum levels of beta-human chorionic gonadotrophin (β-hCG) were negative. The mass measured 18 × 18 mm in diameter, and color Doppler ultrasound (US) excluded vascularization (color score 1). Transvaginal ultrasound revealed a hyperechoic inhomogeneous mass in the uterine cavity, within the fundus and posterior part of the endometrial cavity infiltrating also myometrium up to 10 mm from uterine serosa, suggestive of retained products of conception (RPOC). Hospitalization was uneventful, and she was discharged home 4 days after delivery.įorty days later, on her routine postnatal follow-up, she complained for persistent spot bleeding. She was managed medically with Syntocinon and ergometrine initially followed by dilation and curettage. Twenty-four hours postnatally, she developed postpartum hemorrhage (PPH). The cesarean section was standard and uncomplicated. The mother’s body mass index (BMI) before cesarean section was 26, and her body temperature, blood pressure, and heart rate were within normal limits (36.8 ☌, 128/77 mmHg, and 79 beats per minute (bpm), respectively). A 40-year-old nulliparous woman with no previous gynecological operations underwent at 39 weeks of gestational age a caesarean section due to breech presentation.
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