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Diagnostic Accuracy of Sonographic and Clinical Parameters in the Prediction of Retained Products of Conception

Department of Obstetrics and Gynecology, University of Zagreb, School of Medicine, Zagreb, Croatia (R.M., M.K., L.Z.-H.); and Department of Obstetrics and Gynecology, University Hospital for Tumors, Zagreb, Croatia (O.G.).

Address correspondence to Ozren Grgic, MD, Department of Obstetrics and Gynecology, University Hospital for Tumors, Ilica 197, 10000 Zagreb, Croatia. E-mail: ozren.grgic{at}gmail.hr

Objective. The purpose of this study was to assess the diagnostic accuracy of different parameters (clinical and sonographic) in the prediction and management of retained products of conception (RPOC) in the late postpartum period. Methods. This was a prospective cohort 3-year audit. Predefined data were collected and compared with histopathologic (HP) reports after uterine evacuation. The primary outcome measure was the diagnostic accuracy of different clinical and sonographic parameters, including color Doppler imaging in diagnosis of RPOC confirmed on HP reports. Secondary outcome measures were complication rates influencing maternal morbidity. Results. In total, 93 patients (0.92% of all deliveries) were selected. The presence of gestational tissue was confirmed on HP reports in 58% of cases. The likelihood ratio of sonography alone was 1.47 (95% confidence interval, 1.25–1.84), whereas that of sonography combined with color Doppler imaging was 2.16 (1.3–3.59), providing statistically significant accuracy regarding the prediction of RPOC. Conclusions. Sonography alone or combined with color Doppler imaging has better diagnostic accuracy than the usual clinical parameters used for the prediction of RPOC.

Key Words: cervical dilatation • color Doppler sonography • placenta • residua • sonography • vaginal bleeding

Abbreviations: CI, confidence interval • HP, histopathologic • LR+, positive likelihood ratio • NPV, negative predictive value • PPH, postpartum hemorrhage • PPV, positive predictive value • RPOC, retained products of conception