Delayed surgical and non-surgical treatment of placental remnants: no difference was found in the clinical efficacy and long-term pregnancy outcomes

Figures & data

Figure 1 The diagram of the clinical outcomes of the included patients.

Abbreviations: D&C, dilatation and curettage; H/L, hysteroscopy or laparoscopy; UAE, uterine artery embolization.

Table 1 Clinical features of all the patients with placental remnants after delivery/termination of pregnancy at the second or third trimester

Features
General
Age (years), mean ± SD	29.4±4.8
Gestation (times), median (interquartile range)	2 (2–4)
Parity (times), median (interquartile range)	0 (0–1)
Number of patients who had past operation of uterine cavity, n (%)	43 (66.2)
Pregnancy related
Gestational age
12–28 weeks, n (%)	50 (76.9)
28–40 weeks, n	15
Way of delivery, n
Vaginal delivery	60
Cesarean delivery	5
Reasons for termination at the second trimester
Fetal deformity	5
Fetal chromosome abnormality	1
Intrauterine fetal death	6
Preterm premature rupture of membrane	5
Patient’s required induced abortion	22
Severe comorbidity	1
Late abortion	10
Symptoms
Vaginal bleeding, n (%)	45 (69.2)
Fever, n	9
Abdominal pain, n	16
None, n	13

Table 2 Clinical efficacy of different delayed treatments of placental remnants

Measurements	Non-surgical (n=35)	Surgical (n=24)	P-value
Age (years)	30.7±4.3	27.2±5.2	0.009
Size of the placental remnant (median diameter, cm)	4.0±1.9	4.0±1.7	0.908
Marked vascularity under color Doppler	57.1% (20)	66.7% (16)	0.462
Thinner myometrium or inseparable with myometrium	45.7% (16)	58.3% (14)	0.342
Postpartum interval between delivery/termination of pregnancy to intervention (days)	17 (7, 53)	76 (18, 104)	0.002
Interval for color Doppler ultrasound to became normal (months)	5.0 (3, 6.5)	4.8 (2.4, 6.4)	0.353a
Interval for menstruation to return normal (termination at second trimester)	n=23, 1.5 (1, 3)	n=22, 2 (1, 4.3)	0.751a

Notes:

a Analysis of covariates was used to control age and the postpartum interval between delivery/termination of pregnancy to intervention. Mean ± SD was used to describe normally distributed data and median (interquartile range) was used to describe non-normally distributed data. Significantly different data was shown in bold.

Table 3 Comparisons of the clinical efficacy of single expectant treatment, expectant treatment assisted with UAE, D&C and H/L treatments

Measurements	P
	Single expectant treatment, n=21	Expectant treatment with UAE, n=14	D&C, n=16	H/L treatments, n=8
Interval for color ultrasound to became normal	1	0.017	0.970	0.183
	0.017	1	0.043	0.503
	0.183	0.503	0.182	1
	Single expectant treatment, n=11	Expectant treatment with UAE, n=12	D&C, n=15	H/L treatments, n=7
Interval for menstruation to return normal	1	0.225	0.631	0.276
	0.225	1	0.471	0.981
	0.276	0.981	0.480	1

Notes: Significantly different data was shown in bold. Each line shows the comparison result of different treatments. For example, the first line means: compared with the treatment method of single expectant treatment, expectant treatment with UAE was significantly different (with P value of 0.017), while D&C and H/L were comparable (with P values of 0.97 and 0.183, respectively).

Abbreviations: D&C, dilatation and curettage; H/L, hysteroscopy or laparoscopy; UAE, uterine artery embolization.

Table 4 Conception rate, time to conception and obstetric outcomes of the patients after treatments of placental remnants

	Desired pregnancy	Follow-up (months)	Conception rate (no of person times)	Time to conceptiona (months)	Sterility rate	Live birth rate (no of person times)	Ongoing pregnancy	Ongoing pregnancy/live birth rate	Miscarriage rate
Successfully treated by non-surgical treatments	17	26 (23–102)	94.1% (16/17)	14.6 (1 1.8–36.1)	5.9% (1/17)	50% (9/18)	16.7% (3/18)	66.7% (12/18)	33.3% (6/18)
Successfully treated by delayed surgical treatments	11	58 (36–110)	90.9% (10/11)	19 (6.8–37.6)	9.1% (1/11)	75% (9/12)	8.3% (1/12)	(12/18) 83.3% (10/12)	16.7% (2/12)
P-value	–	0.018	1.00	0.429	1.00	0.26	–	0.419	0.419
Successfully treated patients (surgical + non-surgical)	28	37(24–102)	92.9% (26/28)	16 (10.9–36.3)	7.1% (2/28)	60% (18/30)	13.3% (4/30)	73.3% (22/30)	26.7% (8/30)

Notes:

a The time to conception was the interval between delivery/terminations of pregnancy and the time of a subsequent conception (months). No of person times means if the patient conceived twice after treatment, it was calculated as 2 person times. Median (interquartile range) was used to describe non-normally distributed data, such as follow-up length. Significantly different data was shown in bold.