Immediate and long-term complications of delayed surgical management in the postpartum period: a retrospective analysis

Abstract

Objective: To assess the rate of complications of surgical interventions delayed more than 24 h after delivery in women suspected of placental remnants.

Methods: A retrospective review was performed to analyse complications of delayed surgical interventions. Women were identified from the operation database and their medical records were reviewed to determine the rate of immediate and long-term complications, including reproductive outcome.

Result: A total of 127 women were evaluated. The median interval between delivery and surgery was 42 days. Immediate complications were registered in 22.0% and re-interventions in 16.5%. Placental remnants were histologically confirmed in 63.8%. Intrauterine adhesions (IUAs), only of the severe type, were recorded in 20.5%, although a minority of women was hysteroscopically revised. The difference between women treated by dilatation and curettage (D&C) and hysteroscopy was not statistically significant. Similar reproductive outcomes were encountered in women treated by D&C and hysteroscopy and in women with and without IUAs, although the samples were small.

Conclusion: Identification of placental remnants remains difficult while delayed interventions are associated with significant immediate and long-term complications. The impact on reproductive performance remains unclear. Further research is necessary to examine treatment options in relation to complications and reproductive outcome.

• Adhesions
• Asherman syndrome
• placental remnant
• reproductive outcome
• surgery

Declaration of interest

AH is a member of the Advisory Board, a lecturer for Nordic Pharma and received honoraria. LM and EP have no disclosures to report. AT is a member of the Advisory Board for Hysteroscopy Gynecare for Ethicon, Inc., Johnson & Johnson, Olympus Surgical Advisory Board for Gynaecology, Hologic Advisory Board for minimal invasive procedures, Advisory Board of Gideon Richter for Esmya and is a trainer for Essure hysteroscopic sterilization, Versapoint hysteroscopic surgery and laparoscopic surgery Gynecare for Ethicon, Inc., Johnson & Johnson), Thunderbeat and LESS procedures for Olympus Europa Holding GmbH and is principal investigator Altaseal study, device for hysteroscopic sterilisation for Vasorum Medical Device Research and Development and principal investigator & consultant of the Ablate study, device for endometrial ablation, for AEGEA medical, Inc., and member of the Clinical Evaluation Committee international multicentre HiFU study: “Therapeutic MRI-guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids”.