Placental Remnant Removal With the Hysteroscopic Morcellator

Study Objective
To investigate the the effectiveness of removal of placental remnants with the hysteroscopic morcellator (Myosure, Hologic).

Design
Prospective trial multicenter.

Setting
Two Teaching Hospitals.

Patients
Patients with a placental remnant or miscarriage remnant were treated with a hysteroscopic morcellator to remove the remnant.

Intervention
Patients who complained of persisting bloodloss after delivery or miscarriage underwent a transvaginal ultrasound. If there was a suspicion of a placentalremnant, confirmation was achieved by hysteroscopy. If a remnants was present, patient could decide to be treated immediately in the office, or to get an appointment to be treated in the OR. Prospective data were registered in a CRF.

Measurements and Main Results
The prospective CRF consisted patientdata. Number of days after delivery or miscarriage, the size of the remnant measured on the day of surgery by TVU, the location of the remnant seen by hysteroscopy, time needed to remove the remnant, vision during removal and blood loss as well as fluidloss. Moreover the patient filled in a VAS score if she was treated in the office. Overall 39 patients were treated. 9 patients in the OR and 22 patient in the office with a placental remnant after delivery and 8 after a miscarriage. All patients but one could be treated adequately in one visit. One patient had fluid loss of more than 1000cc. One patient bloodloss 500 cc. The VAS had a mean of 2.3 on a scale of 0 till 10 for the patient wthout anesthesia.

Conclusion
Morcellation of placental remnant seems feasible with the Myosure morcellator (Hologic). As an office procedure it was scored in 95% as acceptable by the patients.