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

Abstract

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.

Diagnostic Accuracy of Ultrasound in Detecting Retained Products of Conception: A Study from a Tertiary Care Hospital in Karachi, Pakistan

“…Another similar study by Matijevic et al [4] reported a 98% sensitivity and 33% specificity for the detection of RPOC using the predefined sonographic criteria (including the presence of a mass >10 mm with echogenic patterns in the endometrium and low resistive index on Doppler), while Chopra et al [11] reported sensitivity (92%), specificity (60%), PPV (87.3%), and NPV (71.4%) using the criteria of endometrial echogenicity alone (thickness was measured if echogenicity was normal). Esmaeillou et al [12] examined both color Doppler and gray-scale ultrasonography and used a variety of criteria to define RPOC; they found that while a criterion of endometrial thickness greater than 1 0mm gave a perfect (100%) sensitivity and NPV, the addition of color Doppler criteria improved the diagnostic accuracy overall.…”

Histopathological Results and the Outcome of Women Who Underwent Postpartum Evacuation and Pelvic Ultrasound Scan

“…An Indian study reported the following values: sensitivity of 92%, specificity of 60%, PPV of 87.3%, and NPV of 71.4%. 16 …”

Agreement of Transvaginal Ultrasound (TVS) and Per Operative Findings in Detecting Retained Products of Conception

“…RPOCs is defined as persistence of placental or fetal tissue in the uterus following delivery, termination of pregnancy or a miscarriage 1,4 . RPOCs is common cause of PPH after uterine atony.…”