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Role of Sonography in the Diagnosis of Retained Products of Conception

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; and Sackler Faculty of Medicine, Tel-Aviv, Israel.

Address correspondence and reprint requests to Oscar Sadan, MD, Department of Obstetrics and Gynecology, Edith Wolfson Center, PO Box 5, Holon 58100, Israel. E-mail: oscars{at}post.tau.ac.il.

Objective. To present our experience with clinical and sonographic diagnosis of retained products of conception and to evaluate its correlation with histopathologic findings. Methods. This was a retrospective study on 156 patients admitted for retained products of conception. Women were referred because of 1 or more of the following: abdominal pain, bleeding, and fever. The status of the cervix was evaluated by bimanual examination. The diagnosis of retained products of conception was made when a sonographic finding of hyperechoic or hypoechoic material was seen in any part of the uterine cavity or the presence of a thickened endometrial stripe greater than 8 mm and an irregular interface between the endometrium and myometrium was found. One hundred twenty-one women (77.6%) were admitted after dilation and curettage for abortion, and 35 (22.4%) were admitted after spontaneous labor. Results. Histopathologic reports confirmed the diagnosis of retained products of conception in 86 (71%) of 121 women in the postabortion group and in 17 (48.5%) of 35 women in the postpartum group. The overall false-positive rate for sonographic diagnosis was 34%. For women after abortion and after delivery, the false-positive rates were 28.9% and 51.5%, respectively. Conclusions. Reliance on common signs and symptoms to diagnose retained products of conception as well as the use of sonography is associated with an unacceptably high false-positive rate, mainly after delivery. A more conservative approach to the treatment of retained products of conception is suggested.

Key Words: abortion • residua • retained placenta • sonography

Abbreviations: D&C, dilation and curettage • RPOC, retained products of conception

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