Accuracy of Diagnosis of Retained Products of Conception After Dilation and Evacuation

Abstract

Objective. Uterine re-evacuation samples taken in cases of suspected residua after curettage are occasionally negative for gestational tissue. We aimed at evaluating the occurrence of such postcurettage re-evacuation-negative samples and at exploring factors that may influence their occurrence. Methods. This was a cross-sectional comparative retrospective study of 69 consecutive women who underwent uterine re-evacuation for suspected postcurettage gestational remnants. Pathologic reports of samples drawn during re-evacuations were reviewed to determine whether the extracted tissue contained gestational tissue. The presence of factors that may influence the rate of a positive or negative sample (eg, sonographic findings, gestational age at initial procedure, and presenting symptom) was noted and compared between women with and without histologically verified remnants. Results. Twenty-eight (41%) of the re-evacuation samples were histopathologically positive for gestational remnants. Residual tissue was more commonly found when the initial evacuation was performed at a more advanced gestational age (>15 weeks). Women referred by emergency department attendants had significantly fewer positive samples. Normal expert sonographic examination practically excluded yielding samples. Conversely, no negative samples were preceded by sonographic reports mentioning residua. Conclusions. Most re-evacuation samples taken during a re-evacuation procedure for suspected residua are negative for gestational tissue. Parameters that are likely related to histologically confirmed gestational residual tissue are advanced gestational age at initial evacuation, level of the sonographer's skill, persistent bleeding as the presenting symptom, and a sonographic report specifically mentioning retained gestational tissue. Key words: abortion, recurettage, residua. t is not uncommon to encounter a woman with findings suggestive of remnants of conception within the endometrial cavity after a dilation and evacuation (D&E) procedure for termination of pregnancy or miscarriage. Irregular vaginal bleeding, abdominal cramps, amenorrhea, and fever with or without vaginal discharge are conditions consistent with residual content. Occasionally, such patients are asymptomatic and their condition is detected after incidental sonographic findings of residual tissue on a scan done for various indications.There are no clear-cut guidelines for the treatment of suspected remnants after curettage; hence, women suspected of having postabortion residua are treated according to local protocols, which include sonographic confirmation of the suspicion by an expert sonogra-

Best predictors of grayscale ultrasound combined with color doppler in the diagnosis of retained products of conception

“…Most of the literature is based on grayscale sonographic features that include the following: (1) focal echogenic endometrial mass; (2) thickened endometrium; (3) complex endometrial fluid 9–14, 19–25. Of these features, the most useful predictor of RPOC is reported to be a focal echogenic mass in the endometrium 10, 13.…”

Diagnostic Accuracy of Sonographic and Clinical Parameters in the Prediction of Retained Products of Conception

“…1 The diagnosis of RPOC relies on different clinical symptoms and signs as well as sonographic assessment. [2][3][4][5][6][7][8][9][10][11] After making a diagnosis, evacuation of the RPOC is indicated, and it is performed in approximately 70% of patients referred with secondary PPH. 4 This is a relatively simple procedure that is generally thought to be safe.…”

Sonographic Appearances of the Endometrium After Termination of Pregnancy in Asymptomatic Versus Symptomatic Women

“…4 Accurate differentiation of RPOC from other acute post-termination complications may prevent unnecessary repeated curettage, with its associated increased rate of complications. Indeed, Maslovitz et al 5 reported that most re-evacuation samples taken for suspected RPOC after early TOP were negative for chorionic villi, and an earlier study from our institution found only 55% women undergoing evacuation to have histologically confirmed RPOC. 1 The diagnosis of RPOC is often difficult on clinical grounds alone, 2 and sonography has traditionally played a role.…”