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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:579-586 • 0278-4297

Sonographic Appearances of the Endometrium After Termination of Pregnancy in Asymptomatic Versus Symptomatic Women

Rachael L. McEwing, MBChB, FRANZCR, Nigel G. Anderson, MBChB, FRANZCR, Jeremy B. A. Meates, MBChB, FRANZCOG, MRCOG, Richard B. Allen, DMU, Greg T. M. Phillipson, MBChB, FRANZCOG and J. Elisabeth Wells, BSc (Hons), PhD

Departments of Radiology (R.L.M.) and Obstetrics and Gynecology (G.T.M.P.), Christchurch Women’s Hospital, Christchurch, New Zealand; Departments of Radiology (N.G.A.) and Public Health and General Practice (J.E.W.), University of Otago, Christchurch, New Zealand; Department of Obstetrics and Gynecology, Hawke’s Bay Hospital, Hastings, New Zealand (J.B.A.M.); and Department of Radiology, Flinders Medical Center, Adelaide, South Australia, Australia (R.B.A.).

Address correspondence to Rachael L. McEwing, MBChB, FRANZCR, Department of Radiology, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand., E-mail: rachaelm{at}cdhb.govt.nz

Objective. The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. Methods. Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. Results. There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1–29 mm] versus 15.3 mm [range, 1.8–34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. Conclusions. Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP.

Key Words: retained products • sonography • termination of pregnancy

Abbreviations: RI, resistive index • RPOC, retained products of conception • TOP, termination of pregnancy

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