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.

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.

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.

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 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.

scholarly journals Subinvolution of the placental site as the cause of hysterectomy in young woman

2021 ◽  
Vol 14 (2) ◽  
pp. e238945
Author(s):  
Olga Triantafyllidou ◽  
Stavroula Kastora ◽  
Irini Messini ◽  
Dimitrios Kalampokis
Keyword(s):  
Young Woman ◽  
Young Women ◽  
Postpartum Haemorrhage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Fertility Sparing ◽  
Placental Site ◽  
Retained Products

Subinvolution of placental sites (SPSs) is a rare but severe cause of secondary postpartum haemorrhage (PPH). SPS is characterised by the abnormal persistence of large, dilated, superficially modified spiral arteries in the absence of retained products of conception. It is an important cause of morbidity and mortality of young women. In this study, we present a case of secondary PPH in a young woman after uncomplicated caesarean delivery who was deemed clinically unstable, and finally, underwent emergent total abdominal hysterectomy. We reviewed the literature with an emphasis on the pathophysiology of this situation. Treatment of patients with SPS includes conservative medical therapy, hysterectomy and fertility-sparing percutaneous embolotherapy.

scholarly journals Overview of Neo-Vascular Lesions after Delivery or Miscarriage

2021 ◽  
Vol 10 (5) ◽  
pp. 1084
Author(s):  
Yuji Shiina
Keyword(s):  
Arteriovenous Malformations ◽  
Uterine Artery ◽  
Spontaneous Regression ◽  
Vascular Diseases ◽  
Vascular Lesions ◽  
Artery Pseudoaneurysm ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Uterine Artery Pseudoaneurysm ◽  
Retained Products

The concept of intrauterine neo-vascular lesions after pregnancy, initially called placental polyps, has changed gradually. Now, based on diagnostic imaging, such lesions are defined as retained products of conception (RPOC) with vascularization. The lesions appear after delivery or miscarriage, and they are accompanied by frequent abundant vascularization in the myometrium attached to the remnant. Many of these vascular lesions have been reported to resolve spontaneously within a few months. Acquired arteriovenous malformations (AVMs) must be considered in the differential diagnosis of RPOC with vascularization. AVMs are errors of morphogenesis. The lesions start to be constructed at the time of placenta formation. These lesions do not show spontaneous regression. Although these two lesions are recognized as neo-vascular lesions, neo-vascular lesions on imaging may represent conditions other than these two lesions (e.g., peritrophoblastic flow, uterine artery pseudoaneurysm, and villous-derived malignancies). Detecting vasculature at the placenta–myometrium interface and classifying vascular diseases according to hemodynamics in the remnant would facilitate the development of specific treatments.

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