Design: Case study

Setting: Operating theatre under general anaesthesia

Patients or Participants: A 41-year-old P2L2 presented with first-trimester pregnancy loss. She was medically managed and yet had persistent minimal bleeding for over 4 weeks. A pelvic examination showed minimal bleeding from the cervix. A transvaginal ultrasound(tvs) showed a hypervascular echoic area of 2 x 2 cm involving the endometrium and myometrium, which persisted after 4 weeks of giving a single dose Injection Methotrexate 50 mg/m².

Interventions: 20 IU of diluted vasopressin ( 20 IU in 100 ml ) is injected paracervically at 5 and 7 ‘0 clock positions. A 22Fr bipolar resectoscope with the loop is advanced into the cavity. Normal saline is used a distention media, and intrauterine pressures are controlled with Hamou Hysteromat at 100 mm of water. The RPOC is located posteriorly in the mid cavity. The vessels are coagulated with short bursts of energy. The loop is pushed against the RPOC to separate it. Once the vessels are coagulated, a slicing technique is used to remove the RPOC. As the women did not desire future pregnancy, the area of RPOC resected deeper to prevent bleeding postoperatively.

Measurements and Main Results: The RPOC was resected completely in a single sitting, without haemorrhage. The procedure time was 10 minutes No complications were noted. Woman was discharged the same day. Histopathology of the specimen confirmed products of conception. The woman is followed up until her next cycle, which was uneventful with normal flow.

Conclusion:

A tvs with Doppler to check the vascularity during follow-up after medical management, the use of paracervical vasopressin, and the use of current to coagulate the vessels before resection of the RPOC helps us plan surgery, preventing intraoperative complication of life threatening haemorrhage.