Placental remnants following birth are often heralded by secondary post-partum haemorrhage. Diagnosis is assisted by an ultrasound scan, with MRI indicated when the scan is inconclusive. Emergency measures are required for excessive bleeding. A conservative approach is appropriate when bleeding is not heavy. Confirmation of intra-uterine placental tissue by repeated scans ensures surgery is confined to women with a high chance of retained tissue. Traditional curettage is often replaced by hysteroscopic resection allowing direct and precise removal of placental remnants with less trauma to adjacent normal endometrium. Hysteroscopic treatment, under general anaesthetic or as an outpatient, is preferably deferred for 2–3 months after delivery to minimise complications, without compromising longer-term outcomes like fertility or subsequent pregnancy rates. Intra-uterine adhesions may occur especially following repeated blind curettage, which can compromise future fertility. Clear communication with the patient and partner is important. Further research into the management options for postdelivery placental remnants is required to ascertain best practice.

The first part of this chapter has been written with the patient’s journey in mind: from the time of presentation to the general practitioner (GP) with a problem such as abnormal uterine bleeding, through referral to secondary care for investigation, including hysteroscopy if appropriate, and to treatment as indicated. We hope this approach will clarify what is involved in providing such a service. In the second half of the chapter, the equipment required for providing hysteroscopy services is described in detail, making extensive use of published standards and guidelines for gynaecology and hysteroscopy specifically.