Clinical Outcomes of Combined Medical and Surgical Treatment for Infected Retained Products of Conception.

OBJECTIVE

To evaluate the clinical outcomes of a combined treatment strategy, referred to as the "Cooling Down Protocol," involving medical management with antibiotics followed by elective hysteroscopy for infected retained products of conception (RPOC).

DESIGN

Retrospective case series.

SETTING

Single tertiary university-affiliated medical center.

PATIENTS: 32 patients treated between 2012 and 2023 with a diagnosis of infected retained products of conception.

INTERVENTIONS: Initial treatment involved antibiotic therapy as part of the Cooling Down Protocol, with elective hysteroscopy performed to ensure complete removal of retained tissue.

RESULTS

97% of patients achieved infection resolution. Only one case required urgent surgical intervention due to clinical deterioration. Elective hysteroscopy was performed in 20% of cases, and the overall complication rate was 9.4%, including minor infections, hemorrhage, and pelvic pain. Importantly, the "minor infections" referred to post-procedural infections, as all patients initially presented with active infection. No major complications like sepsis or thromboembolic events were observed. The incidence of intrauterine adhesions was 10%, lower than rates for traditional D&C.

CONCLUSION

The study supports the Cooling Down Protocol as a reasonable treatment alternative to more invasive methods, minimizing risks and optimizing patient outcomes.