Operative hysteroscopy vs vacuum aspiration for treatment of retained products of conception: A systematic review and meta-analysis.

OBJECTIVE: To generate comparative evidence on outcomes of hysteroscopic (HS) vs vacuum aspiration (VA) for retained products of conception (RPOC). METHODOLOGY: We included all study designs comparing HS with VA for RPOC and available on PubMed, CENTRAL, Scopus, Embase, and Web of Science up to 15th January 2025. Surgical and pregnancy outcomes were analyzed. RESULTS: Four studies were included. Meta-analysis showed that procedure duration was significantly longer with HS as compared to VA. The risk of intra-operative and post-operative complications did not differ between the two groups. The risk of incomplete evacuation of RPOC was significantly lower with HS as compared to VA with no difference in the risk of uterine perforation or hemorrhage ≥500ml. There was a tendency of higher risk of conversion to another procedure with HS as compared to VA. Meta-analysis showed that conception rates and subsequent risk of miscarriage did not significantly differ between the two groups. CONCLUSIONS: Limited evidence suggests that HS for RPOC may result in a lower risk of incomplete evacuation but has a longer procedural duration as compared to VA. The risk of complications and pregnancy outcomes do not seem to differ between the two. However, important fertility-related outcomes, including intrauterine adhesions, live birth rates, time to conception, and placental complications, could not be adequately assessed due to limited data. The quality of evidence is low due to scarce literature.