[Effectiveness and safety of non-surgical management for intrauterine retained products of conception: A prospective observational study].

objectivesIntrantering retained products of conception (RPOC) are common postpartum or post-abortion complications. Although surgical management is effective, it carries risks such as endometrial injury and potential negative impacts on fertility. Retrospective studies suggest that non-surgical treatment may be safe and effective for selected patients with RPOC; however, prospective evidence remains lacking. This study aims to prospectively evaluate the effectiveness and safety of non-surgical management for RPOC.

methodsClinical data of patients diagnosed with intrauterine RPOC by ultrasound and presenting for the first time at the outpatient clinic of the Department of Gynecology and Obstetrics of the Third Xiangya Hospital, Central South University, from January 2023 to December 2024 were prospectively collected. Outcomes assessed included spontaneous expulsion of retained tissue, conversion to surgical treatment, and the incidence of heavy bleeding or infection during non-surgical management.

resultsA total of 275 patients with intrauterine RPOC were enrolled. Among them, 181 patients (65.82%) experienced spontaneous expulsion, 25 (9.09%) remained under non-surgical management, and 69 (25.09%) converted to surgical treatment. Of the 69 patients, 64 had no complications but opted for surgery due to unwillingness to continue waiting, while 5 patients underwent emergency hospitalization for heavy bleeding and subsequently converted to surgery after medical stabilization. Among the 181 patients with spontaneous expulsion, the median time to RPOC resolution was 81.0 (57.0, 106.5) days. The distribution of expulsion time was as follows: with 30 days, 3 cases (1.66%); 31-60 days, 45 cases (24.86%); 61-90 days, 59 cases (32.60%); 91-120 days, 45 cases (24.86%); ≥121 days, 29 cases (16.02%). For the 69 patients who underwent surgery, the median waiting time was 73 (53, 101) days. Time-to-surgery distribution was as follows: within 30 days of pregnancy termination, 5 cases (7.25%); 31-60 days, 14 cases (20.29%); 61-90 days, 26 cases (37.68%); 91-120 days, 12 cases (17.39%); ≥121 days, 12 cases (17.39%). During non-surgical management, 8 patients (2.91%) developed heavy bleeding; all were successfully managed with inpatient medical treatment, with marked reduction in bleeding, and none required uterine artery embolization or hysterectomy. Among these, 5 converted to surgery, while 3 chose to continue non-surgical management and subsequently expelled the retained tissue spontaneously. Four patients showed elevated C-reactive protein levels, but none exhibited clinical signs of infection. For the 64 complication-free patients who elected surgery due to personal preference, paired comparisons between their complications between their initial and preoperative evaluations showed significant reductions in β-human chorionic gonadotropin (β-hCG), uterine volume, and maximum diameter of retained tissue, as well as decreases in vascular flow grading and the proportion of enhanced myometrial vascularity (EMV) (all

conclusionsIn the absence of active bleeding or infection, non-surgical management of intrauterine RPOC is effective and relatively safe and may be considered an alternative treatment option.