The Sonographic and Color Doppler Features of Retained Products of Conception

Abstract

Objective. The purpose of this study was to identify the sonographic features of retained products of conception (RPOCs). Methods. Cases of clinically suspected RPOCs referred for pelvic sonography between September 1994 and July 2001 were identified. Patient age, indication, gestational age at delivery, and days postpartum were recorded and sonographic findings were reviewed. Outcomes were determined from medical records and pathology reports. Results. One hundred sixty-three cases were identified. Indications for pelvic sonography included vaginal bleeding in 82 (50%), pelvic pain in 77 (47%), and fever in 55 (34%). Gestational age at delivery ranged from 14 to 43 weeks (mean, 37 weeks), and the sonographic examination was performed from 0 to 95 days postpartum (mean, 21 days). Thirty-six patients underwent surgical intervention, and 28 of these had RPOCs. The remaining 127 patients were followed clinically. An endometrial mass was the most sensitive (79%) and specific (89%) sonographic feature for RPOCs. The isolated finding of either complex fluid in the endometrial canal or a thick endometrium measuring greater than 10 mm had low sensitivity, specificity, and negative and positive predictive values. None of the patients with RPOCs had normal sonographic findings. The absence of an endometrial mass or complex fluid and an endometrial thickness of less than 10 mm were considered normal findings. Color Doppler flow was detected in the endometrium somewhat more often when RPOCs were present than in the absence of RPOCs (75% versus 40%). Conclusions. An endometrial mass is the most sensitive finding for RPOCs. If no mass or endometrial fluid is seen and the endometrial thickness is less than 10 mm, RPOCs are extremely unlikely. The absence of blood flow does not exclude the diagnosis of RPOCs.

Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception

“…The endometrial vascularity was seen in all 15 cases of retained product of conception in this study, which was consistent with the studies of Kamaya, et al 1 and Durfee, et al 2 8.08% patients dropped their Hb by at least 2 gr/dL but only 1 of these had IEV. The authors hypothesised that the vascularity of the endometrium in the contexts of RPOC and SPPH may be explained on the basis of neoangiogenesis in that area.…”

“…In the study of Kamaya, et al, 1 the incidence was much higher and the degree of vascularity was graded from 0 to 3. All patients in this study, who had IEV, had RPOC which is consistent with the study of Durfee, et al 2 Endometrial vascularity was significantly higher in pregnant patients with live births than in those who miscarried 3 …”

Retained products of conception mimicking a large endometrial AVM: Complete resolution following spontaneous abortion

“…2 Color Doppler flow is detected in the endometrium more often when RPOC are present than in the absence of RPOC (75% versus 40%, respectively). 1 Durfee et al 1 observed that the presence of blood flow on color Doppler imaging was not helpful in distinguishing the presence or absence of retained products, although blood flow was seen somewhat more commonly in the endometrium with retained products than without. Some retained products may have minimal or very slow blood flow despite failure of complete separation at delivery.…”

“…1,3 Color Doppler flow is more often detected in the endometrium when RPOC are present (75%) than in the absence of RPOC (40%). 1 Complete hydatidiform mole presents as a complex intrauterine mass with multiple anechoic areas of varying sizes (ie, a \snowstorm" appearance). 4 The sonographic features of an arteriovenous malformation (AVM) are often indistinguishable from those seen in gestational trophoblastic disease (GTD) and residual trophoblastic tissue in spontaneous abortion.…”

“…1,2 Endometrial mass is the most sensitive (79%) and specific (89%) sonographic feature for RPOC. 1,3 Color Doppler flow is more often detected in the endometrium when RPOC are present (75%) than in the absence of RPOC (40%). 1 Complete hydatidiform mole presents as a complex intrauterine mass with multiple anechoic areas of varying sizes (ie, a \snowstorm" appearance).…”