Hysteroscopic morcellation for removal of persistent placental remnants in the uterine cornu: Two case reports.

Abstract

RATIONALE:

Hysteroscopic morcellation is an alternative approach for the removal of placental remnants, given its advantages of safety, efficiency and good reproductive outcomes. This superiority can be even more obvious for removing persistent placental remnants in the lateral angle of the uterine cavity after repeated dilation and curettage (D&C) of an angular pregnancy, which is rarely reported.

PATIENT CONCERNS:

Two patients who were both initially misdiagnosed as having missed intrauterine miscarriages underwent repeated suction-assisted D&C procedures and were found to have persistent placental remnants in the lateral angles of the uterine cavity.

DIAGNOSES:

Ultrasound and hysteroscopy evaluations showed that placental remnants in both cases were in the lateral uterine angles and protruding to the interstitial myometrium around the fallopian tube. We corrected the diagnosis to that of angular pregnancy according to a comprehensive consideration of the ultrasound, hysteroscopy and pathology results.

INTERVENTIONS:

We performed MyoSure hysteroscopic morcellation for both patients and the placental remnants were removed completely without any complication.

OUTCOMES:

The patients were both scheduled for a second-look hysteroscopy 1 to 3 months after surgery, which revealed normal morphology of the uterine cavities and tubal ostia. The patients both achieved normal intrauterine pregnancies several months after surgery.

LESSONS:

Hysteroscopic morcellation is a good alternative approach for the removal of placental remnants and should be considered in cases in which there might be a high risk of incomplete evacuation or a high risk of uterine perforation, especially in cases of angular pregnancy.

• Authors: Fan Yu, Zhimin Li, Yi Wang, Zhen Yue, Yuanyue Zhong, Liqin Zeng
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 16 Pg. e24097 (Apr 23 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 33879654 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Topics

• Adult
• Female
• Humans
• Hysteroscopy (methods)
• Morcellation (methods)
• Placenta (diagnostic imaging, surgery)
• Pregnancy
• Pregnancy, Angular (diagnosis, surgery)
• Ultrasonography, Prenatal
• Uterus (pathology, surgery)