Conservative management of retained products of conception in the normal placental position: A retrospective observational study

Takahashi, Hironori; Ohhashi, Mai; Baba, Yoshifumi; Nagayama, Shiho; Ogoyama, Manabu; Horie, Kenji; Suzuki, Hiroyoshi; Usui, Rie; Matsubara, Shigeki

doi:10.1016/j.ejogrb.2019.06.016

Cited by 19 publications

(29 citation statements)

References 27 publications

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“…Takahashi et al conducted a retrospective observational study of 59 patients with RPOC, and in 23 (39%) patients, conservative management resulted in the resolution of RPOC. 3 However, it is of note that their cohort was different from ours: the previous study mostly included preterm (n = 7) and term (n = 40) deliveries, and there were only 12 (20%) cases of abortion.…”

Section: Discussionmentioning

confidence: 63%

“…2 RPOC represents a leading cause of postabortion or postpartum hemorrhage. 3 Surgical management, such as dilatation and curettage (D&C) or transcervical hysteroscopic resection (TCR), has been employed; however, these procedures can induce significant bleeding during procedures, thereby requiring hysterectomy. 4 Although transcatheter uterine artery embolization (UAE) has also been a forceful remedy, 5 the potential adverse effect on consequent pregnancy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, several studies have reported the efficacy of conservative management for RPOC. 3,6 Unfortunately, however, RPOC refers to a large spectrum that contains various preceding pregnancies ranging from early gestational age to term pregnancy. As it has yet to be elucidated which population of RPOC could benefit from expectant management, and villi before midpregnancy are considered to have high proliferative capacity, it is important to focus on RPOC with a preceding pregnancy of less than 22 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Conservative management for retained products of conception after less than 22 weeks of gestation

Shitanaka

Chigusa

Kawahara

et al. 2020

J of Obstet and Gynaecol

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Aim: The aim of the study was to investigate the efficacy of conservative treatment in cases of retained products of conception (RPOC) with a preceding pregnancy of less than 22 weeks and to assess whether serum beta-human chorionic gonadotropin (hCG) levels could be a useful index to monitor the progress of treatment. Methods: This is a case series of patients with RPOC developed after less than 22 weeks of gestation and managed expectantly with serial serum hCG measurement between 2011 and 2017. The clinical data of subjects were reviewed retrospectively. Cases that did not require invasive treatment such as surgery were designated as conservative management success. Results: A total of 19 cases were eligible: 14 miscarriages and 5 induced abortions. Eleven patients underwent dilatation and curettage. The diagnosis of RPOC was made 35 (8-80) days after abortion. All patients were successfully treated with conservative management. Serum hCG levels at diagnosis were 29.6 (3.2-1585) mIU/mL. Serial measurement of serum hCG was continued until the levels became lower than the cutoff value, and the mean duration to hCG disappearance was 67.5 (6-183) days. In all cases, RPOC vanished spontaneously 77 (27-184) days after diagnosis. The disappearance of RPOC in the uterine cavity was subsequent to a significant decrease in serum hCG. Once serum hCG levels reached the cutoff value, no bleeding episodes were observed. Conclusion: Conservative management for RPOC might be acceptable and effective. Furthermore, serial serum hCG levels reflect the activity of RPOC, and hCG may be a reliable index to monitor the progress of treatment.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conservative management for retained products of conception after less than 22 weeks of gestation

Shitanaka

Chigusa

Kawahara

et al. 2020

J of Obstet and Gynaecol

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“…A previous retrospective study from our institution regarding the conservative management of RPOC-ARC reported that, of the 319 medical abortions at 12–21 weeks of gestation, 75 (24%) had a sonographically-identified EMV, but all these EMV resolved spontaneously, regardless of symptoms, and none with an associated massive bleeding required an invasive treatment [ 7 ]. On the other hand, another retrospective study reported that of their 59 RPOCs, including 40 (68%) labors after term, 36 (61%) required interventions due to bleeding-related events, such as significant bleeding (20/36) or continuous small amounts of bleeding (16/36) [ 8 ]. These results suggest that conservative management for RPOC-ARC is effective, but that the need for aggressive intervention increases as the number of gestational weeks of delivery advances.…”

Section: Discussionmentioning

confidence: 99%

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Kobayashi

Nakagawa

Kawanishi

et al. 2021

BMC Pregnancy Childbirth

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Background The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. Methods We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. Results The range of gestational age at delivery in our study was 12–21 weeks in 61 cases, 22–36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9–47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. Conclusion The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.

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“…Retained placenta can spontaneously resolve with conservative management. Hence, asymptomatic patients with small and non-hypervascularized retained placenta may be candidates for conservative management [17][18][19]. In this study, 15 patients underwent expectant management after TAE.…”

Section: Clinical Outcomementioning

confidence: 99%

Angiographic Features and Transarterial Embolization of Retained Placenta With Abnormal Vaginal Bleeding

Takaji

Kiyosue

Maruno

et al. 2021

Preprint

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Objectives: To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding.Methods: The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results: Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase (tentatively named “serpiginous blood sinus”) in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients.Conclusions: The characteristic angiographic feature of retained placenta is “serpiginous blood sinus.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

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Conservative management of retained products of conception in the normal placental position: A retrospective observational study

Cited by 19 publications

References 27 publications

Conservative management for retained products of conception after less than 22 weeks of gestation

Conservative management for retained products of conception after less than 22 weeks of gestation

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Angiographic Features and Transarterial Embolization of Retained Placenta With Abnormal Vaginal Bleeding

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