# Predictors for Using Electricity During Hysteroscopic Removal of Retained Products of Conception

## TL;DR

This study identifies factors that predict the need for electrosurgery during hysteroscopic removal of retained pregnancy tissue, helping improve surgical planning.

## Contribution

The study provides novel preoperative predictors for electrosurgical use in hysteroscopic RPOC removal.

## Key findings

- Older age, postpartum RPOC, manual placental removal, and Doppler vascularity are independent predictors of electrosurgery use.
- Electrosurgery was more common after vaginal delivery and in cases with larger RPOC size.
- No significant differences in short-term postoperative complications were observed between groups.

## Abstract

Background: Retained products of conception (RPOC) can be managed via hysteroscopic removal using mechanical or electrosurgical techniques. Electrosurgery introduces greater technical complexity and may reflect more adherent or vascular tissue, yet preoperative predictors for its necessity remain poorly defined. Objective: The objective of this study was to evaluate clinical outcomes and identify preoperative predictors associated with the use of electrosurgery during hysteroscopic removal of RPOC. Methods: In this retrospective cohort study conducted at a single tertiary center, we reviewed 551 cases of hysteroscopic RPOC removal performed between January 2008 and December 2022. Patients were categorized based on intraoperative use of electrosurgical instruments. Clinical, sonographic, and operative data were compared between groups. Multivariate logistic regression was used to identify independent predictors of electrosurgical use. Results: Electrosurgical intervention was required in 84 patients (15.2%). Compared with those treated without electricity, these patients were older (33.2 ± 6.4 vs. 31.2 ± 5.8 years, p = 0.004), more likely to be smokers (15.4% vs. 8.1%, p = 0.033), and had higher rates of prior hysteroscopy (5.9% vs. 1.0%, p = 0.002). Electrosurgical use was more common following vaginal delivery than abortion (57.1% vs. 24.8%, p < 0.001), particularly when manual placental removal was performed (23.8% vs. 5.7%, p < 0.001). Larger RPOC size and positive Doppler flow were also associated with the use of electrosurgery. On multivariate analysis, maternal age, postpartum RPOC, manual placental removal, and Doppler vascularity remained independent predictors. No significant differences were observed in short-term postoperative complications. Conclusions: Older age, postpartum RPOC, manualysis, and vascularity on ultrasound are preoperative predictors for the need of electrosurgical intervention during hysteroscopic removal of RPOC. Identifying these factors may improve surgical planning and patient counseling. Future prospective studies incorporating advanced hysteroscopic technologies are warranted.