Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound

Abstract

Background. Retained products of conception is an important diagnosis to consider in patients presenting with postpartum complaints. Bedside ultrasound is a rapid, accurate, noninvasive modality to evaluate these patients. Objective. To report an atypical case of retained products of conception diagnosed with bedside ultrasound in the emergency department. Case Report. A 27-year-old female who was 1-month postpartum presented with vaginal bleeding, pelvic pain, and no fever. At the time of initial H&P, bedside ultrasound revealed echogenic material within the endometrial cavity with blood flow seen by color Doppler consistent with retained products of conception. The bedside ultrasound rapidly narrowed the differential and allowed a definitive diagnosis immediately. Ob/Gyn was consulted and dilation and curettage was performed in the operating room. Conclusions. Retained products of conception is an important diagnosis for the emergency physician to consider in at-risk patients. The sonographic findings are easily obtained and interpreted by emergency physicians. Earlier diagnosis of this disease process should lead to more focused patient evaluations and management.

The Diagnostic Accuracy of Ultrasound in Retained Products of Conception in Postpartum Period by Using Histopathology as the Gold Standard

“…When a postpartum individual has indications of endometritis or hemorrhage, particularly bleeding, vaginal discharge, or pelvic pain, and fever, RPOC must be suspected. 11,12 In our study, study subjects were found to have 31. In this study sensitivity ultrasonography showed specificity, sensitivity, NPV, PPV and accuracy were 63.9%, 87.8%, 81.2%, 74.7%, and 77% respectively by taking histopathology as gold standard.…”

“…In emergency departments, though the accessibility of radiology could be limited and the frequent utilization of bedside ultrasonographic imaging by emergency physicians would translate well into this use. 11 Hyperechoic, intrauterine material involving internal vascularity found with Color-Doppler and low-resistance flow, high-velocity via spectral Doppler are usual sonographic findings. Blood products can have an echogenic presentation similar to that however without internal flow.…”

Better use of available radiology resources for women's health in Latin America and the Caribbean

“…This imaging technique can accurately date a pregnancy; identify fetal abnormalities, malpresentation, multiple gestations, and placenta previa; and allow a physician to manage the pregnancy properly and improve outcomes (33). Ultrasound is the imaging modality of choice for the postpartum patient who is febrile or experiencing complications such as vaginal discharge, bleeding, and pain (34, 35). In many developing countries—especially in rural communities—obstetric services, including ultrasound services and trained individuals to perform the exams, are extremely limited or nonexistent, leaving women vulnerable to poor outcomes.…”

Agreement of Transvaginal Ultrasound (TVS) and Per Operative Findings in Detecting Retained Products of Conception

“…RPOCs is defined as persistence of placental or fetal tissue in the uterus following delivery, termination of pregnancy or a miscarriage 1,4 . RPOCs is common cause of PPH after uterine atony.…”