Hysteroscopy and curettage as an alternative treatment of late postpartum hemorrhage

Late postpartum hemorrhage due to retained products of conception is a not infrequent obstetrical complication. The use of Doppler ultrasound is essential for accurate diagnosis and surgical removal is often required. Classically uterine curettage is performed, either sharp or by mechanical suction. This is a dangerous intervention because postpartum uterus is extremely friable and the risk of uterine perforation is high. Therefore, an alternative treatment is hysteroscopy, allowing a direct view of the cavity, providing both diagnosis and treatment in one intervention, preventing uterine adhesions formation, preserving fertility, reducing hospital stay and postoperative complications. However, it is suggested that hysteroscopy is not useful if: there is heavy bleeding, vaginal delivery is recent and / or the size of retained placental fragments are larger than 4 cm.

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