scholarly journals Ultrasound features help identify patients who can undergo noninvasive management for suspected retained products of conception: a single institutional experience

2021 ◽  
Author(s):  
Shrilakshmi Vyas ◽  
Hailey H. Choi ◽  
Sara Whetstone ◽  
Priyanka Jha ◽  
Liina Poder ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Pregnancy Termination ◽  
Peak Systolic Velocity ◽  
Resistive Index ◽  
Management Approach ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Retained Products ◽  
Endometrial Vascularity

Abstract Objectives To evaluate ultrasound (US) features associated with successful noninvasive management for suspected retained products of conception (RPOC). Methods In this IRB-approved retrospective study, the radiology report database was queried for pelvic US with keywords of postpartum hemorrhage (PPH) and/or RPOC over a 2-year period. Follow-up exams, US exams without clinical follow-up, suboptimal image quality, and > 1 year from delivery or pregnancy termination were excluded. Charts were reviewed for clinical presentation and management. Two radiologists reviewed images for endometrial thickness, endometrial echogenicity, endometrial vascularity, and enhanced myometrial vascularity (EMV), as well as inner myometrial peak systolic velocity (PSV) and resistive index (RI) where available. Features were assessed for associations with management approach, and test characteristics were calculated. Results Initial query yielded 196 exams, and 48 were excluded. A total of 148 patients were included. Mean age was 34.2 years (21–47), and mean time from delivery or pregnancy termination was 40.4 days (0–223). 81 (55%) underwent noninvasive management: 72 (48%) expectant and 9 (6%) medical. 67 (45%) underwent invasive management: 60 (41%) surgical and 7 (5%) uterine artery embolization. There was substantial inter-reader agreement for assessment of EMV (K = 0.78) and endometrial vascularity (K = 0.72). Thin endometrial stripe, avascular endometrium, and absence of EMV were associated with successful noninvasive management (p < 0.05). Thin endometrium (< 10 mm) had specificity (90%), PPV (88%), and likelihood ratio (5.91) in predicting successful noninvasive management. Conclusion Endometrial thickness < 10 mm, avascular endometrium, and absence of EMV are the sonographic features associated with successful noninvasive management for PPH or suspected RPOC.

CASE SERIES OF INVASIVE MOLE - A LEARNING EXPERIENCE.

2021 ◽  
pp. 22-23
Author(s):  
Japhia David ◽  
Vrunda Joshi ◽  
Jebin Aaron Devarajan
Keyword(s):  
Learning Experience ◽  
Color Doppler ◽  
Case Series ◽  
Normal Vaginal Delivery ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Secondary Postpartum Hemorrhage ◽  
Invasive Mole ◽  
Retained Products

This case series is intended to study the earliest possible modes of diagnosis of invasive mole and its management. In this case series, three scenarios where invasive mole presenting as hypervascular retained products of conception, as acute abdomen due to a perforating lesion and as secondary postpartum hemorrhage following a full term normal vaginal delivery are described. Inferred from the case scenarios, ultrasound with color Doppler can be used as a rst investigation to reduce the time to diagnose interval. Management includes medical treatment with intravenous methotrexate and surgical treatment with a fertility-preserving resection or hysterectomy. Strict ß-HCG follow up is required to prevent missing the diagnosis of malignant transformation of mole.

Ultrasound criteria for managing postpartum patients with suspicion of retention of conception products

2019 ◽  
Vol 61 (2) ◽  
pp. 276-281
Author(s):  
Orna Levinsohn-Tavor ◽  
Noa Feldman ◽  
Ran Svirsky ◽  
Noam Smorgick ◽  
Arava Nir-Yoffe ◽  
...  
Keyword(s):  
Ultrasound Examination ◽  
Individual Risk ◽  
Clinical Approach ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Ultrasound Findings ◽  
Low Probability ◽  
Specific Symptoms ◽  
Retained Products

Background Retention of conception products is a common complication following delivery and remains a diagnostic and management challenge due to non-specific symptoms and ultrasound findings. Purpose To introduce a clinical approach for managing patients with suspected retained products of conception following delivery. Material and Methods The ultrasound examination included gray-scale and Doppler parameters which classified the patients into three groups: high, moderate, or low probability for retained products of conception. The same classification was used both to stratify individual risk for retained products of conception, as well as for counseling the appropriate management. Results The study included 66 patients. Retained products of conception was confirmed in 62%, 32% and 0% of the high, moderate and low probability groups, respectively. Additionally, each group was further divided according to the timing of the ultrasound examination: before or after 42 postpartum days. A significant increase, from 12% to 64%, in the positive predictive value was observed in the moderate probability group when the ultrasound was performed ≥ 42 days postpartum. Conclusions In the low probability group, no surgical intervention is recommended. When ultrasound findings are classified as high probability for retained products of conception, surgical evacuation of the uterine content is recommended. For clinically stable women with ultrasound findings consistent with moderate probability, ultrasound follow-up at the end of the puerperal period (42 days) is recommended. This approach may improve the sonographic prediction of retained products of conception and prevent unnecessary interventions.

Postpartum Retained Products of Conception: A Novel Approach to Follow-Up and Early Diagnosis

2017 ◽  
Vol 39 (06) ◽  
pp. 643-649 ◽  
Author(s):  
Noam Smorgick ◽  
Ayala Krakov ◽  
Ron Maymon ◽  
Moshe Betser ◽  
Josef Tovbin ◽  
...  
Keyword(s):  
At Risk ◽  
Early Diagnosis ◽  
Doppler Flow ◽  
Retained Products Of Conception ◽  
Ultrasound Evaluation ◽  
Novel Approach ◽  
Products Of Conception ◽  
Placental Remnants ◽  
Retained Products

Abstract Purpose To investigate whether ultrasound follow-up for the detection of postpartum retained products of conception (RPOC) in women considered at risk for this condition may allow for early diagnosis. Methods Parturients at risk for RPOC underwent an ultrasound exam on the second postpartum day. Based on the ultrasound findings, women were either: (1) discharged to routine postpartum care in cases of normal scans, (2) invited for follow-up in cases of abnormal scans. We retrospectively analyzed the rates of women requiring uterine evacuation due to persistent abnormal scans. Results 761 parturients (out of 17 010 deliveries, 4.5 %) were included. Of those, 490 (64.4 %) women had a normal initial scan, but two of them were later readmitted for uterine evacuation. The remaining 271 (35.6 %) women were found to have an abnormal scan: (a) thickened endometrium > 10 mm with hypo- and hyper-echoes and negative Doppler flow considered low suspicion for RPOC was described in 260 cases, of whom 23 (8.8 %) underwent uterine evacuation with placental remnants confirmed in 12/23 (52.2 %), and (b) an echogenic mass with positive Doppler flow considered high suspicion for RPOC was described in 11 cases, all of whom underwent uterine evacuation, with placental remnants confirmed in 9/11 (81.8 %). The number of scans required to detect RPOC in one patient was 33. Conclusion Postpartum ultrasound evaluation may allow for early diagnosis of RPOC in women considered at risk for this condition.

scholarly journals A CASE REPORT ON EFFECTIVE MANAGEMENT OF RETAINED PRODUCT OF CONCEPTION THROUGH AYURVEDA REGIMEN

2021 ◽  
pp. 23-28
Author(s):  
Khushboo Jha ◽  
K. Bharathi ◽  
Sonu ◽  
M.S. Anu
Keyword(s):  
Case Report ◽  
Cesarean Delivery ◽  
Female Patient ◽  
Pregnancy Termination ◽  
Modern Medicine ◽  
Effective Management ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Retained Products

The term retained products of conception (RPOC) refers to intrauterine tissue that develops after conception and persists after medical and surgical pregnancy termination, miscarriage, and vaginal or cesarean delivery. Approximately half of the conceptions are not even recognized 10- 15% is lost during 1st trimester and additional 2-3% is lost in later pregnancy. The word abortion means expulsion from the uterus of the product of conception before the fetus is viable. This period of viability is different in different views. In modern medicine the period of viability is taken as 7 months. In Ayurveda this abortion is mentioned with the name of Garbhasrava or Garbhapata. A 30 yr old female patient came to NIA opd with a complaint of heavy bleed continously since 1 month. On examination it was found, she has taken MTP pill from local clinic. D and C was done though she was getting her bleed continously. Then, she came to NIA opd for futher management and was given Dashmool Kwatha, Ajmodadi Churna, Triphala Guggulu and Prataplankeshwar ras for 7 days. Then the patient was advised for USG which revealed no retained product of conception.

Managing patients with suspected postpartum retained products of conception using a novel sonographic classification

2021 ◽  
pp. 028418512199146
Author(s):  
Orna Levinsohn-Tavor ◽  
Nataly Zilberman Sharon ◽  
Noa Feldman ◽  
Ran Svirsky ◽  
Noam Smorgick ◽  
...  
Keyword(s):  
High Probability ◽  
Surgical Interventions ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Management Protocol ◽  
Patients At Risk ◽  
Low Probability ◽  
Sonographic Classification ◽  
Retained Products

Background Suspicion of retained products of conception (RPOC) often arises after delivery and still poses a diagnostic and management challenge. Purpose To prospectively evaluate a sonographic classification for the management of patients with suspected RPOC after delivery. Material and Methods Based on grayscale and Doppler ultrasound parameters, patients were classified into high, moderate, or low probability of RPOC. For the low and moderate probability groups, an ultrasound follow-up at the end of the puerperium was recommended. For the high probability group, a follow-up examination was conducted 10–14 days after the first ultrasound, and patients with persistent high probability findings were referred for surgical intervention. Results The sample was composed of 215 patients at risk of RPOC. Of these, 100, 93, and 22 patients were classified as having a low, moderate, or high probability of RPOC, respectively. Rates of RPOC were 55%, 2%, and 2% in the high, moderate, and low probability categories, respectively. When the categorization was based on the most recent ultrasound obtained during the puerperium, the adjusted RPOC prevalence rates were 71% in the high, 6% in the moderate, and 0% in the low probability groups. Conclusion This study confirms the effectiveness of our sonographic classification for managing patients with suspected RPOC after delivery. In all three categories, it is recommended to adhere to a conservative management protocol in clinically stable women until the end of the puerperium. This approach provides good predictability for RPOC and can reduce unnecessary surgical interventions.

scholarly journals Correlation of ultrasound with histopathology for retained products of conception in medically managed abortions

2017 ◽  
Vol 6 (8) ◽  
pp. 3372
Author(s):  
Namita Chopra ◽  
Manpreet Kaur ◽  
Manjit Kaur Mohi
Keyword(s):  
Predictive Value ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
High Sensitivity ◽  
Medical Abortion ◽  
P Value ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Retained Products

Background: Medical abortion uses an anti-progestin, mifepristone (RU486), followed by a prostaglandin (misoprostol). Objective of present study was to correlate findings of transvaginal ultrasound with histopathology for retained products of conception in medical abortions.Methods: An observational, prospective study was conducted on hundred women with gestation upto 12 weeks who underwent medical abortion with excessive or prolonged post abortal vaginal bleeding. Transvaginal scan followed by uterine evacuation was done under anesthesia, followed by histopathology.Results: Analysis was done statistically using Pearson Chi- square method. Sixty five percent subjects took MTP pill by unsupervised, self-intake and 35% on prescription. Among women who took misoprostol in dose of 400mcg, 89% had RPOC on histopathology. At the dose of 800 mcg, 73.3% had retained Products of Conception (RPOC) on histopathology. The correlation was found to be statistically non-significant (p value at 5% was 1.13). Ultrasound showed echogenic mass in the uterine cavity in 62 (62%) women, increased endometrial thickness ≥10mm in 13 (13%), gestational sac with no fetal pole in 6 (6%), blood clots in uterine cavity in 6 (6%), and empty uterine cavity in 3 (3%). Seventy five percent of women had histologically proven RPOC at endometrial cut off of equal to or greater than 10mm. The sensitivity, specificity, positive and negative predictive value of transvaginal ultrasonography in detection of retained products of conception were 92%, 60%, 87.3%, 71.4% respectively. The diagnostic accuracy was 84%.Conclusions: Transvaginal ultrasound for detecting retained products of conception in medically managed abortions has a high sensitivity and positive predictive value and is useful for screening women with clinically suspected incomplete abortion who require further intervention -medical or surgical.

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