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Fertility outcome after treatment of retained products of conception : a systematic review

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Abstract
Background: Treatment of retained products of conception (RPOC) can be expectant, medical or operative. Surgical removal of RPOC may lead to intrauterine adhesions (IUA) and Asherman's syndrome. Objective: To evaluate how treatment options for RPOC affect future fertility by means of a systematic review. Search strategy: MEDLINE, EMBASE, The Cochrane Library, and clinical trial registers were searched, and reference lists were scanned. Selection criteria: Randomised controlled trials (RCT) comparing different treatment options for RPOC (conservative, medical or surgical treatment, including curettage and/or hysteroscopic techniques, with or without application of anti-adhesion therapy), in women of reproductive age, were eligible for inclusion. Data collection and analysis: Reviewers independently performed data extraction and quality of evidence assessment. For dichotomous variables, results were presented as risk ratio (RR) with 95% CI. Main results: Two studies were included. Nonsignificant differences were observed between the use of an anti-adhesion barrier gel versus no treatment after operative hysteroscopy in IUAs (RR 0.32, 95% CI 0.04 to 2.80, P value = 0.30) and clinical pregnancy (RR 2.22, 95% CI 0.67 to 7.42, P value = 0.19), and between hysteroscopic morcellation versus loop resection in IUAs (RR 0.86, 95% CI 0.06 to 13.12, P value = 0.91). Conclusion: There is insufficient evidence on how different treatment options for RPOC affect future reproductive outcomes. Results from ongoing RCTs are needed to guide clinicians towards choosing the best treatment.
Keywords
RESIDUAL TROPHOBLASTIC TISSUE, HYSTEROSCOPIC MANAGEMENT, OPERATIVE, HYSTEROSCOPY, PLACENTAL REMNANTS, CURETTAGE, MORCELLATION, DIAGNOSIS, RESECTION, REMOVAL, Retained products of conception, Treatment, Fertility, Reproductive, outcome, Systematic review

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MLA
Hamerlynck, Tjalina, et al. “Fertility Outcome after Treatment of Retained Products of Conception : A Systematic Review.” GYNECOLOGICAL SURGERY, vol. 15, 2018, doi:10.1186/s10397-018-1044-6.
APA
Hamerlynck, T., Meyers, D., Van der Veken, H., Bosteels, J., & Weyers, S. (2018). Fertility outcome after treatment of retained products of conception : a systematic review. GYNECOLOGICAL SURGERY, 15. https://doi.org/10.1186/s10397-018-1044-6
Chicago author-date
Hamerlynck, Tjalina, Dora Meyers, Hannelore Van der Veken, Jan Bosteels, and Steven Weyers. 2018. “Fertility Outcome after Treatment of Retained Products of Conception : A Systematic Review.” GYNECOLOGICAL SURGERY 15. https://doi.org/10.1186/s10397-018-1044-6.
Chicago author-date (all authors)
Hamerlynck, Tjalina, Dora Meyers, Hannelore Van der Veken, Jan Bosteels, and Steven Weyers. 2018. “Fertility Outcome after Treatment of Retained Products of Conception : A Systematic Review.” GYNECOLOGICAL SURGERY 15. doi:10.1186/s10397-018-1044-6.
Vancouver
1.
Hamerlynck T, Meyers D, Van der Veken H, Bosteels J, Weyers S. Fertility outcome after treatment of retained products of conception : a systematic review. GYNECOLOGICAL SURGERY. 2018;15.
IEEE
[1]
T. Hamerlynck, D. Meyers, H. Van der Veken, J. Bosteels, and S. Weyers, “Fertility outcome after treatment of retained products of conception : a systematic review,” GYNECOLOGICAL SURGERY, vol. 15, 2018.
@article{8570098,
  abstract     = {{Background: Treatment of retained products of conception (RPOC) can be expectant, medical or operative. Surgical removal of RPOC may lead to intrauterine adhesions (IUA) and Asherman's syndrome. 
Objective: To evaluate how treatment options for RPOC affect future fertility by means of a systematic review. Search strategy: MEDLINE, EMBASE, The Cochrane Library, and clinical trial registers were searched, and reference lists were scanned. 
Selection criteria: Randomised controlled trials (RCT) comparing different treatment options for RPOC (conservative, medical or surgical treatment, including curettage and/or hysteroscopic techniques, with or without application of anti-adhesion therapy), in women of reproductive age, were eligible for inclusion. 
Data collection and analysis: Reviewers independently performed data extraction and quality of evidence assessment. For dichotomous variables, results were presented as risk ratio (RR) with 95% CI. 
Main results: Two studies were included. Nonsignificant differences were observed between the use of an anti-adhesion barrier gel versus no treatment after operative hysteroscopy in IUAs (RR 0.32, 95% CI 0.04 to 2.80, P value = 0.30) and clinical pregnancy (RR 2.22, 95% CI 0.67 to 7.42, P value = 0.19), and between hysteroscopic morcellation versus loop resection in IUAs (RR 0.86, 95% CI 0.06 to 13.12, P value = 0.91). 
Conclusion: There is insufficient evidence on how different treatment options for RPOC affect future reproductive outcomes. Results from ongoing RCTs are needed to guide clinicians towards choosing the best treatment.}},
  articleno    = {{12}},
  author       = {{Hamerlynck, Tjalina and Meyers, Dora and Van der Veken, Hannelore and Bosteels, Jan and Weyers, Steven}},
  issn         = {{1613-2076}},
  journal      = {{GYNECOLOGICAL SURGERY}},
  keywords     = {{RESIDUAL TROPHOBLASTIC TISSUE,HYSTEROSCOPIC MANAGEMENT,OPERATIVE,HYSTEROSCOPY,PLACENTAL REMNANTS,CURETTAGE,MORCELLATION,DIAGNOSIS,RESECTION,REMOVAL,Retained products of conception,Treatment,Fertility,Reproductive,outcome,Systematic review}},
  language     = {{eng}},
  pages        = {{7}},
  title        = {{Fertility outcome after treatment of retained products of conception : a systematic review}},
  url          = {{http://dx.doi.org/10.1186/s10397-018-1044-6}},
  volume       = {{15}},
  year         = {{2018}},
}

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