Role of transvaginal sonography in the diagnosis of retained products of conception

Üstünyurt, Emin; Kaymak, Oktay; İskender, Cantekin; Ustunyurt, Özlem Basak; Çelik, Cem; Danışman, Nuri

doi:10.1007/s00404-007-0436-z

Cited by 44 publications

(34 citation statements)

References 12 publications

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“…Several studies have looked at different gray scale sonographic features of RPOC, including the presence of an intrauterine mass, 2 endometrial thickness, 3,4 and echogenicity. 5 These prior studies did not focus on the color Doppler features of RPOC, and in fact, color Doppler imaging was not routinely performed in many of the study patients.…”

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confidence: 99%

Retained Products of Conception

Kamaya

Petrovitch

Chen

et al. 2009

J of Ultrasound Medicine

102

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Objective. The purpose of this study was to characterize color Doppler imaging features of retained products of conception (RPOC) with gray scale correlation. Methods. Clinically suspected cases of RPOC between January 2005 and February 2008 were reviewed. Patient data and relevant color Doppler and gray scale features were recorded. Results. A total of 269 patients referred for sonographic evaluation for RPOC were identified. Thirty-five patients had confirmed pathologic diagnoses, 28 of whom had RPOC. In those with RPOC, 5 (18%) were avascular (type 0); 6 (21%) had minimal vascularity (type 1); 12 (43%) had moderate vascularity (type 2); and 5 (18%) had marked vascularity (type 3). Peak systolic velocities ranged from 10 to 108 cm/s (average, 36.1 cm/s). Resistive indices in arterial waveforms ranged from 0.33 to 0.7 (average, 0.5). Five (45%) of the patients with type 0 vascularity had RPOC; 6 (86%) of those with type 1 had RPOC; and 17 (100%) of those with types 2 and 3 had RPOC. An echogenic mass had a moderate positive predictive value (80%) but low sensitivity (29%) for RPOC. Conclusions. Color Doppler evaluation of the endometrium is helpful in determining the presence of RPOC. Endometrial vascularity is highly correlated with RPOC, whereas the lack of vascularity can be seen in both intrauterine clots and avascular RPOC.

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confidence: 99%

Retained Products of Conception

Kamaya

Petrovitch

Chen

et al. 2009

J of Ultrasound Medicine

102

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“…Ustunyurt et al were unable to demonstrate a cut off level, below which RPOC can be accurately excluded. 9 The negative predictive value was 63% at cut off level of 10 mm and 50 % at 8mm. Sawyer et al found no clear cut off value for endometrial thickness to differentiate between RPOC and decidua in his study.…”

Section: Discussionmentioning

confidence: 91%

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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“…In cases of retained products of conception ultrasound can differentiate between retained products and endometritis [Zuckerman et al 1997] Even tiny retained products of conception as occurs in first trimester miscarriage is accurately detected by TVS with Doppler application [Ustunyurt et al, 2007] …”

Section: Post-partum Complicationsmentioning

confidence: 99%