Retained Products of Conception

Title of Image: Retained Products of Conception
Description of Image: Sagittal image from a transvaginal sonogram in a patient with bleeding after a spontaneous abortion. The endometrium (between cursors) was thick and heterogeneous, measuring 8.5 mm in thickness (Fig1). Color doppler image in same patient shows focal flow (Fig. 2 - arrow) within the heterogeneous endometrium. Subsequent dilatation and evacuation (D&E) revealed retained products of conception (RPOC). The endometrial thickness may be useful to evaluate for RPOC. If the endometrium is very thin, RPOC are unlikely. A thicker endometrium is more likely to contain products of conception (Fig 1). Unfortunately, it is unclear what endometrial thickness measurement best distinguishes patients without and with RPOC. When endometrial thickness is less than 10 mm, clinically significant RPOC are reported to be unlikely. Another study reported 100% sensitivity and 80% specificity for RPOC using an endometrial thickness cutoff of 8 mm. The presence of detectable flow by Doppler ultrasound within an endometrial mass or in a thickened endometrium seems to be more indicative of RPOC (Fig 2), whereas absence of flow may favor clot. We use Doppler ultrasound, but do not fully rely on it.

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