Clinical outcomes after hysteroscopic removal of retained products of conception with or without prior uterine artery embolization

Skuk, Eva (author), Vihtelič, Polona (author), Popović, Peter (author), Kovač, Kaja (author), Verdenik, Ivan (author), Kenda Šuster, Nataša (author)

Purpose: Retained products of conception (RPOC) are a common complication after pregnancy. While hysteroscopic resection is the standard treatment when RPOC does not resolve spontaneously, highly vascular tissue can lead to severe bleeding during the procedure. This study assessed clinical outcomes, procedural safety, and reproductive performance in patients with highly vascular RPOC treated with uterine artery embolization (UAE) prior to hysteroscopy, compared to those treated with hysteroscopy alone. Methods: This retrospective study included 42 women diagnosed with RPOC at University Medical Centre Ljubljana, Slovenia (2010-2020). Patients were divided into two groups: UAE followed by hysteroscopic resection (UAE + HSC, n = 21) and hysteroscopic resection alone (HSC-only, n = 21). Data on clinical outcomes, complications, and reproductive history were analyzed using Fisher's exact and t-tests (p < 0.05). Results: Groups were similar in baseline characteristics, except for greater vascularity in the UAE + HSC group (100% vs. 4.8%, p < 0.05). Bleeding >300 mL occurred more often in the UAE + HSC group, but all cases were managed conservatively and only one patient required transfusion. No uterine perforations occurred. Residual RPOC was found in one patient per group. Rates of endometritis, menstrual changes, and pelvic pain were comparable. Among those who attempted conception, live birth and miscarriage rates did not differ significantly. Conclusions: UAE prior to hysteroscopic surgery appears to be a safe and effective option for highly vascular RPOC, especially in patients at risk of hemorrhage, with no adverse impact on fertility. Further prospective studies are recommended.

• Language: English
• Keywords: retained products of conception, uterine artery embolization, hysteroscopy, fertility, high vascularity, reproductive outcomes
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: 10 str.
• Numbering: Vol. 14, iss. 22, art. 8020
• PID: 20.500.12556/RUL-182307
• UDC: 618.1
• ISSN on article: 2077-0383
• DOI: 10.3390/jcm14228020
• COBISS.SI-ID: 275156995
• Publication date in RUL: 08.05.2026

Record is a part of a journal

• Title: Journal of clinical medicine
• Shortened title: J. clin. med.
• Publisher: MDPI
• ISSN: 2077-0383
• COBISS.SI-ID: 5405759

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: plodnost, visoka prekrvavljenost, histeroskopija, reproduktivni izidi, zadržani produkti spočetja, embolizacija maternične arterije