Accurate Detection of Retained Products of Conception after First- and Second-trimester Abortion by Color Doppler Sonography

Esmaeillou, Hajieh; Jamal, Ashraf; Eslamian, L.; Marsousi, Vajiheh; Sarvi, Fatemeh; Kokab, Abas

doi:10.1016/j.jmu.2014.10.006

Cited by 14 publications

(12 citation statements)

References 17 publications

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“…Using histopathology as confirmatory test, the overall sensitivity of TVS for diagnosis of RPOC in present study is 92% which is comparable to study conducted by De Vries et al, Matijevic et al and Esmaeillou et al [11][12][13] The overall specificity of TVS is 60%, which is comparable to that in study conducted by Esmaeillou et al, higher than in study conducted by Matijevic et but lower than other studies. 12,13 This is because of relatively high number of false positive results which might be due to false interpretation of blood clot for RPOC which also looks like echogenic mass on ultrasound or presence of thickened endometrium giving impression of RPOC but proved to be thickened decidua with absence of chorionic villi on histopathology.…”

Section: Discussionsupporting

confidence: 76%

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

Chopra

Kaur

Mohi

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONThe global abortion rate is estimated at 28 per 1000 women of reproductive age but varies within regions. Medical abortion uses an anti-progestin, mifepristone (RU486), followed by a prostaglandin (misoprostol). Medical abortion is preferred from four up to seven or nine weeks.1 WHO 2014 has laid down guidelines for dosage of mifepristone and misoprostol-Upto 9 weeksMifepristone 200 mg oral, single dose followed by misoprostol 800 mcg vaginal, buccal or sublingual single dose. From 9 to 12 weeks-mifepristone 200 mg oral single dose followed by Misoprostol 800 mcg, then 400 mcg vaginal, followed by sublingual or vaginal every 3 hours up to 5 doses, 36-48 hours after Mifepristone.Vaginal bleeding with medical abortion generally lasts for 9 days on an average. Woman should seek medical ABSTRACT 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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Section: Discussionsupporting

confidence: 76%

“…12,13 This is because of relatively high number of false positive results which might be due to false interpretation of blood clot for RPOC which also looks like echogenic mass on ultrasound or presence of thickened endometrium giving impression of RPOC but proved to be thickened decidua with absence of chorionic villi on histopathology.…”

Section: Discussionmentioning

confidence: 99%

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

Chopra

Kaur

Mohi

2017

Int J Reprod Contracept Obstet Gynecol

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“…Detecting RPOC with transvaginal ultrasound is a noninvasive assessment tool before medical or surgical treatments. [ 1 ] Several kinds of sonographic features of RPOC were reported, such as endometrial mass, greater endometrial thickness (ET), and high endometrial vascularity.…”

Section: Discussionmentioning

confidence: 99%

“…Esmaeillou et al . compared the diagnostic performance of ET ≥10 mm, vascular pattern, and endometrial echogenic mass;[ 1 ] they found that combination of endometrial vascularity and hyperechoic mass is the best predictor of RPOC, with 88% sensitivity, 89% specificity, 85% positive predictive value, and 93% negative predictive value. They also found that ET ≥10 mm is a doubtful parameter in detecting RPOC, because 52% patients with ET ≥10 mm had no RPOC, in other words a high false-positive rate.…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic management of retained products of conception

Yu-Hui

Cheng

Ding

2018

Gynecol Minim Invasive Ther

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We report a case with retained products of conception (RPOC) managed by hysteroscopic resection. A 45-year-old woman, G5P3SA1AA1, experienced spontaneous abortion on March 8, 2017, and had persistent vaginal bleeding since then. On May 12, 2017, she came to emergency room where endometrium biopsy was done and revealed degenerative gestational tissue with acute inflammation. On May 23, 2017, she followed up at outpatient department where ultrasonography showed no obvious intrauterine abnormalities with endometrial thickness of 6.5 mm. Office hysteroscopy was arranged and RPOC at the posterior uterine wall was suspected. She received hysteroscopic transcervical resection (TCR) of RPOC on May 26, 2017. After TCR, the vaginal bleeding discontinued. The pathology showed degenerative gestational products with acute inflammation. In conclusion, hysteroscopic TCR might be safe and feasible for RPOC.

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“…Each measurement was taken twice with a 5-min interval and the average values were used in analysis. A transvaginal color Doppler ultrasound has been shown to have a 88% sensitivity and 68% specificity in diagnosis of RPOC [29]. Furthermore, the decreased measures of AP-diameter of RPOC has been shown to be an indicator of complete spontaneous resolution [30].…”

Section: Outcome Measurementsmentioning

confidence: 99%

Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study

Vafaei

Ajdari

Hessami

et al. 2020

BMC Complement Med Ther

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Background: Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion. Materials and methods: In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study. Results: After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects. Conclusion: This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed. Trial registration: This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.

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Accurate Detection of Retained Products of Conception after First- and Second-trimester Abortion by Color Doppler Sonography

Cited by 14 publications

References 17 publications

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

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

Hysteroscopic management of retained products of conception

Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study

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