Retained products of conception (RPOC) may occur after miscarriage, pregnancy termination, and vaginal or cesarean delivery [
4]. One of the most important risk factors that may lead to RPOC is placenta accreta, defined as abnormal attachment to the myometrium either in whole or in part [
5]. RPOC may lead to short- and long-term complications. Short-term complications include abdominal vaginal bleeding or spotting and infections, while long-term complications include Asherman’s syndrome, infertility, miscarriages, and pregnancy complications such as placenta accreta [
6]. Ultrasonography is useful in order to evaluate RPOC, although it is challenging to differentiate blood clots from RPOC. Among the sonographic features that may imply RPOC are endometrial mass, greater endometrial thickness (ET), and high endometrial vascularity. Endometrial mass is the most sensitive (79%) and specific (89%) feature for RPOC [
7]. All in all, the diagnosis is based on the sonographic appearance of intrauterine echogenic material, on patient’s symptoms and signs and on clinical findings [
8].
Surgical management options of this condition include blind curettage, hysteroscopic resection, and hysteroscopic morcellation [
2]. Conventionally, the surgical management of such cases is largely performed using blind dilation and curettage [
3]. Though traditional, blind curettage may cause complications such as uterine perforation, incomplete evacuation with persistence of retained intrauterine products, and Asherman’s syndrome [
9]. On the other hand, blind curettage has shorter learning curve and preprocedure set up compared to the other methods and costs less in the short term [
3]. More recently, hysteroscopic removal has been proposed in the literature as being a superior option to blind curettage. The major advantage of hysteroscopic removal is the possibility to selectively resect RPOC under direct visualization without affecting the adjacent endometrium. A recent meta-analysis included 326 cases of retained products of conception and compared the rates of complications following hysteroscopy and curettage. According to the results, hysteroscopy is superior to traditional curettage as it reduces the risk of uterine perforation and intrauterine adhesion and improved future reproductive outcomes [
10]. However, the hysteroscopic technique of resection of the retained placental tissue may be challenging in the immediate postpartum period due to heavy vaginal bleeding and the risk of perforation [
11]. Bland dissection with the tip of the resectoscope appears to be a quite safe approach with less risk of bleeding or perforation of the uterus. The goal of the method is to evacuate the cavity with minimal endometrial trauma avoiding the use of electrosurgery [
10]. Furthermore, another important advantage of the hysteroscopic management of such cases compared with blind dilation and curettage is the preoperative accidental finding of uterine cavity malformations such as uterine septum [
12].
Another safe alternative method which has gained popularity worldwide is the hysteroscopic morcellation of intrauterine pathology. The hysteroscopic morcellator consists of a set of two hollow tubes that fit into each other and rotate within each other. The tissue can be cut, shaved, and sucked. A recent randomized controlled trial found that hysteroscopic morcellation may be superior to loop resection in the removal of retained placental tissues [
2].