Spectrum of normal intrauterine cavity sonographic findings after first‐trimester abortion.

Abstract

Objective. To characterize the sonographic appearance of the uterine cavity after uncomplicated firsttrimester abortion. Methods. Women who underwent uterine evacuation for first-trimester abortion were referred for endovaginal sonographic examination within the week after the procedure. Special attention was directed to characterizing the intrauterine cavity. Demographic and clinical parameters were collected. A repeated postmenstrual examination was carried out in selected cases. Results. In all, 57, 10, and 7 sonographic examinations were performed after termination of pregnancy, incomplete (spontaneous) abortion, and missed abortion, respectively. Fifty-seven (77%) of the 74 examinations showed considerable amounts of intrauterine content with various echogenicities (anteroposterior thickness range, 7-61 mm). No association could be documented between the pattern of appearance and gravidity, parity, gestational age, or type of abortion procedure. All postmenstrual reevaluations of patients with excessive amounts of intrauterine material at the initial examination (n = 7) showed empty intrauterine cavities. Conclusion. Within the week after firsttrimester abortion, the uterine cavity is seldom empty. Thick heterogeneous material is an expected finding after examination. By being familiar with this normal range of appearances, clinicians can avoid unnecessary repeated invasive evacuation procedures. A follow-up sonographic evaluation during the follicular phase of the next menstrual cycle is recommended to confirm the absence of retained products of pregnancy. Key words: sonography; abortion; intrauterine findings. Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Revision requested May 21, 2001. Revised manuscript accepted for publication July 11, 2001. We thank Merav Seadi for technical assistance and Charlotte Sachs and Gloria Ginzach (Editorial Board, Rabin Medical Center, Beilinson Campus) for assistance. Received April 12, 2001, from the Department ofAddress correspondence and reprint requests to Itai Bar-Hava, MD, Department of Obstetrics and Gynecology, Rabin Medical Center, Golda Campus, Petah Tiqva, Israel. irst-trimester abortion is associated with an overall complication rate of 0.9% to 7%. 1 The estimated rate of repeated curettage is around 0.38, 2 but because first-trimester abortion is so common, the actual number of women with some complication might be more substantial. Women who may not have complications requiring invasive intervention may nevertheless approach their primary physicians with various symptoms such as abdominal pain, cramping, and vaginal bleeding. In such circumstances, uterine cavity evaluation by endovaginal sonography is a well-accepted tool for diagnosis and treatment planning. To our knowledge, however, little information is available regarding the sonographic characteristics of the normal uterine cavity after a first-trimester abortion.

Sonographic appearance of the uterine cavity following administration of mifepristone and misoprostol for termination of pregnancy

“…22 There are limited data regarding the sonographic appearance of the uterine cavity after a medical abortion; however, more information is available regarding the sonographic appearance of the uterine cavity after a spontaneous abortion or surgical abortion in the first trimester. Bar-Hava et al 23 observed that in 77% of their cases of uterine evacuation in first-trimester TOP, a considerable amount of intrauterine content with various echogenicities was sonographically detected within 1 week of the procedure. Sonographic examinations of these patients following their first menses showed an empty intrauterine cavity.…”

Retained products of conception mimicking a large endometrial AVM: Complete resolution following spontaneous abortion

“…Bar-Hava et al 3 emphasized that on sonography the uterine cavity is seldom empty within 1 week after curettage. They suggested that the presence of varying amounts of irregular intrauterine material should be considered a part of the normal range of the sonographic appearance and does not necessarily indicate the presence of RPOC that require intervention.…”

“…1,2 Endometrial mass is the most sensitive (79%) and specific (89%) sonographic feature for RPOC. 1,3 Color Doppler flow is more often detected in the endometrium when RPOC are present (75%) than in the absence of RPOC (40%). 1 Complete hydatidiform mole presents as a complex intrauterine mass with multiple anechoic areas of varying sizes (ie, a \snowstorm" appearance).…”

Accuracy of Diagnosis of Retained Products of Conception After Dilation and Evacuation

“…Decisions on patient referral for re-evacuation are based on clinical grounds supported by sonographic findings both of which have high sensitivity but moderate specificity. 2,3,11,18 Dilation and evacuation is a minor surgical procedure; nevertheless, it is associated with complications, which make a strong argument against its possible misuse. 1 We sought to determine the extent of such post factum unnecessary procedures and to delineate factors that might affect the decision to perform re-evacuation procedures.…”

“…1,5,6 Recently, transvaginal sonohysterography with removal of retained tissue under vision has gained popularity [7][8][9][10] because the ability of a regular sonographic examination to accurately detect retained products of conception has been questioned. [11][12][13] Thus, physicians caring for symptomatic patients who have undergone D&E have to rely on their clinical judgment supplemented by the limited diagnostic capabilities of the sonographic examination to decide between a surgical procedure and continuation of conservative treatment.…”