International Academic Exchange at the 34th ESGE Congress: Insights on Stratified Management of Retained Products of Conception from Zhejiang University

Istanbul, Turkey – October 19-22, 2025 – The 34th Congress of the European Society for Gynaecological Endoscopy (ESGE) was held in Istanbul, Turkey, from October 19 to 22, 2025.

Hysteroscopic techniques and their role in fertility preservation and minimally invasive diagnosis and treatment remained a central focus in the gynaecology sector at the ESGE international academic exchange platform. Dr. Hong Zhan from the Day Surgery Centre of the Women's Hospital, Zhejiang University School of Medicine, delivered a presentation in the plenary session on "Stratified Management of Retained Products of Conception (RPOC) after Early Pregnancy Loss." His further gave an oral presentation on "Fertility Preservation Post-RPOC Treatment" in the dedicated hysteroscopy session.

RPOC following early pregnancy loss is a common clinical challenge, and inappropriate management can adversely affect future fertility potential. The research from our centre evaluated a stratified management strategy. This approach integrates ultrasound-measured residual tissue size, serum beta-human chorionic gonadotropin (β-hCG) levels, and different surgical modalities to optimize clinical management.

Surgical intervention for RPOC is a significant cause of intrauterine adhesions and endometrial injury. To mitigate potential harm to female reproductive health, avoid delays in treatment, and prevent complications, our focus has shifted towards exploring "non-surgical management" options. This aims to assess the efficacy and safety of pharmacological treatment versus surgical intervention, facilitating personalized treatment plans based on individual clinical symptoms and imaging findings.

A retrospective cohort analysis was conducted, including 201 patients with ultrasound-confirmed RPOC after early pregnancy loss. Treatment plans were decided jointly based on clinical parameters and patient preference, stratified primarily by residual tissue diameter and serum β-hCG concentration. The treatment protocols included: (1) Pharmacological Treatment:** Cyclical estrogen-progesterone therapy (28-day regimen). (2) Surgical Treatment: Ultrasound-guided dilatation and curettage (D&C), hysteroscopic resection, and hysteroscopic tissue removal by morcellation). The primary outcome was treatment success, defined as complete evacuation confirmed by ultrasound. Secondary assessments included endometrial thickness during the mid-luteal phase of the first post-intervention menstrual cycle, incidence of intrauterine adhesions, other relevant complications, fertility outcomes, and patient satisfaction. The study findings support implementing a stratified strategy guided by ultrasound for managing RPOC, optimizing both immediate resolution and long-term fertility preservation. Pharmacological therapy demonstrated advantages in endometrial protection for minimal RPOC, while surgical methods were more effective for larger remnants. Serum β-hCG concentration did not show significant prognostic value. Hysteroscopic morcellation was associated with a potentially lower risk of intrauterine adhesions and could be considered a preferred surgical option when intervention is necessary.

The Day Surgery Centre at our hospital is dedicated to research and training in precise hysteroscopic techniques and innovative technologies, committed to promoting female fertility and protecting women's health throughout their life cycle. The findings presented at the congress highlight that non-surgical management strategies for RPOC, whether successfully avoiding surgery altogether or creating safer conditions for subsequent intervention, hold significant importance for endometrial protection and fertility maintenance. These approaches warrant further validation through larger-scale, multi-center prospective studies to firmly establish their core value in widespread clinical practice.

Figure 1 Dr. Zhan Hong delivering her presentation in the Plenary Session.

Figure 2 Dr. Zhan Hong during her oral presentation in the Hysteroscopy Session.

Figure 3 Dr. Zhan Hong with Professor Arvind Vashisht (President of BSGE, first from right) from University College London Hospitals (UCLH).

Figure 4 Dr. Zhan Hong with a member of her team, Zhou Zihan.