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Occurrence and Outcome of Residual Trophoblastic Tissue

A Prospective Study

Department of Obstetrics and Gynecology, University Hospitals, Catholic University of Leuven, Leuven, Belgium (T.V.d.B., D.V.S., D.T.); Department of Obstetrics and Gynecology, Regionaal Ziekenhuis Heilig Hart, Tienen, Belgium (T.V.d.B.); and Department of Electrical Engineering, ESAT-SCD, Catholic University of Leuven, Leuven, Belgium (A.D., N.P., B.D.M.).

Address correspondence to Thierry Van den Bosch, MD, PhD, Department of Obstetrics and Gynecology, University Hospitals, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium. E-mail: thierry.van.den.bosch{at}skynet.be

Objective. The purpose of this study was to evaluate the occurrence of residual trophoblastic tissue after miscarriage or delivery, to assess the diagnostic value of sonography with color Doppler examination in the detection of retained tissue, and to define in what cases expectant management may be an option. Methods. We conducted a prospective observational study using sonography with color Doppler imaging in consecutive patients at routine follow-up after miscarriage or delivery. Expectant management was proposed in all patients with suspected retained tissue providing they were hemodynamically stable and in the absence of signs of infection. In case of surgical removal of retained tissue, the histologic examination was compared with the sonographic findings. Results. In total, 1070 patients were assessed. In 67 patients (6.3%), sonographic and color Doppler examination showed retained tissue, and in 41 (61%) of them, curettage was performed. In all but 1 case, retained tissue was confirmed on histologic examination. Cases of retained tissue were more often seen after first-trimester (17%) or second trimester (40%) miscarriage, in the presence of abnormal uterine bleeding (57%), and with areas of enhanced myometrial vascularity (77.3%). Conclusions. Sonography with color Doppler examination is clinically useful to confirm or exclude residual trophoblastic tissue.

Key Words: enhanced myometrial vascularity • residual trophoblastic tissue • sonography

Abbreviations: AUC, area under the receiver operating characteristic curve • D&C, dilation and curettage • EMV, enhanced myometrial vascularity • LS-SVM, least squares support vector machine • PSV, peak systolic velocity • TOP, termination of pregnancy

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