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. econdary postpartum hemorrhage (PPH), either alone or associated with pain, fever, or both, is a common clinical symptom of retained products of conception (RPOC). 1 The reported incidence in the literature is around 1% of all deliveries, and it represents one of the most common reasons for hospital referral and readmission in the postpartum period.1 The diagnosis of RPOC relies on different clinical symptoms and signs as well as sonographic assessment. 2-11After making a diagnosis, evacuation of the RPOC is indicated, and it is performed in approximately 70% of patients referred with secondary PPH.4 This is a relatively simple procedure that is generally thought to be safe. However, histopathologic (HP) samples obtained on uterine evacuation in cases of suspected RPOC after primary evacuation of the uterus were found to show positive findings for gestational remnants in approximately 60% of cases, whereas in the postpartum group, this incidence is 48.5%. 2,3,6,9 The false-positive rates are 28.9% if the diagnosis is based on sonography and 51.5% if it is based on clinical examination.

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At present, ultrasound scanning has an important role in noninvasive assessment of endometrial and ovarian cyclical changes and may be of particular importance in assisted conception procedures. Further work is likely to help in understanding its full diagnostic potential.

Methods: Prospective cohort study of 316 low-risk pregnant women. Vaginal pH was measured using test gloves for measuring the vaginal acidity, while CL was measured using transvaginal ultrasound. The cut off value for vaginal pH used was 5.0 (95 th centile for our population) whereas shortened CL was defined as < 26 mm (5 th centile for our population).Results: Elevated vaginal pH was found in 4.4% whereas shortened CL was found in 2.8%. The incidence of PTL (< 37 weeks) was 7.2%, and early PTL (< 34 weeks) was 3.4%. Shortened CL is significantly related to PTL (LR weighted by prevalence 2.7, 95% CI 1.1-6.7) but is not to early PTL (LR weighted by prevalence 0.8, 95% CI 0.4-1.8). Elevated vaginal pH is better predictor of PTL (LR weighted by prevalence 3.7, 95% CI 1.3-10.4) and early PTL (LR weighted by prevalence 1.7, 95% CI 1.1-3.1). Conclusion:Elevated vaginal pH has better accuracy in comparison with shortened CL regarding the prediction of early PTL in low risk pregnant women.