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.