Evaluation of placental retentions after 8536 uterine
evacuations
K. Ertopcu, M.M. Inal, Z. Ozenc, A. Donmez, F. Ozdemir, I. Ozelmas, S. Tinar
Aegean Obst & Gyn Teaching and Research Hospital, Family Planning Department,
Izmir, Turkey
Objective To investigate the causes of placental retention (rest
placenta) cases after uterine evacuations applied in our clinic.
Methods
Uterine evacuation applied 8536 cases in between 1 January 1998 and 31 December
2004 in our Family Planning Department were enrolled into the study. Demographic
characteristics (age, number of children, number of abortions, number of
curettages), gestational ages, uterine anomalies like leiomyomas and uterine
septums were compared in revision curettage applied 327 cases because of rest
placenta after uterine evacuation. Uterine evacuations were applied by certified
practitioners under the supervision of gynecologists with carmen cannula
aspiration (menstrual regulation) and by gynecologists in between 5th and 9th
weeks of gestation. Pregnancy and placental retention diagnosis were put by
ultrasonography in all of the cases. The differences in between all of the
groups were evaluated statistically.
Results Revision curettage was applied to
327 (3.83%) of 8536 uterine evacuation applied cases. Most of the uterine
evacuation applied cases were in between 20-30 years of age group (47.3%)
whereas most of the cases with rest placenta were in between 31-40 years of age
(50.8%). Previous number of uterine evacuations, number of children and number
of abortions revealed no statistically significant difference in between the
groups. Because of placental retentions observed after uterine evacuations
performed by certified practitioners, revision curettages performed by certified
practitioners were applied to 28 of 995 cases (2.81%) at 5th gestational week,
84 of 1951 cases (4.3%) at 6th gestational week, 94 of 2036 cases (4.61%) at 7th
gestational week, and 104 of 2089 cases (4.97%) at 8th gestational week, whereas
after uterine evacuations applied by gynecologists at 9th week of gestation,
revision curettage was needed to be applied to 18 of 1465 cases (1.2%) at 9th
gestational week.
Uterine anomalies were observed in 15 cases and leiomyomas
were observed in 36 cases in uterine evacuation group, whereas only 2 uterine
anomaly cases and 1 leiomyoma case were observed in rest placenta group.
Evaluation of the experience of the physicians who performed the uterine
evacuations revealed the rest placenta rates as follows; 52 rest placenta cases
(3%) with the physician who performed 1707 uterine evacuations, 70 rest placenta
cases (4.4%) with the physician who performed 1576 uterine evacuations, 43 rest
placenta cases (3.2%) with the physician who performed 1305 uterine evacuations,
42 rest placenta cases (3.5%) with the physician who performed 1198 uterine
evacuations, 42 rest placenta cases (3.5%) with the physician who performed 1189
uterine evacuations, 35 rest placenta cases (4.4%) with the physician who
performed 797 uterine evacuations, 27 rest placenta cases (5.1%) with the
physician who performed 529 uterine evacuations and 16 rest placenta cases
(6.8%) with the physician who performed 235 uterine evacuations.
Conclusion The
possibility of placental retention increases with the increase in gestational
week of the uterine evacuation applied cases. The rate of rest placenta
decreases with the increase in the total number of uterine evacuations performed
by the physician. And high number of placental retentions observed in cases of
31-40 years of age group was also striking.