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Retained products of conception

Retained products of conception (RPOC) refers to the persistence of placental and/or fetal tissue in the uterus following delivery, termination of pregnancy or a miscarriage

Epidemiology

RPOC can complicate ~1% of all pregnancies. It occurs with greater frequency with:

Clinical presentation

Common symptoms include vaginal bleeding and abdominal or pelvic pain, similar to patients with gestational trophoblastic disease

Differentiation of these entities is important because retained products of conception is treated conservatively or with curettage, while gestational trophoblastic disease may require chemotherapy.

ß-human chorionic gonadotropin (beta-hCG) remains elevated in patients with gestational trophoblastic disease but falls to an undetectable level over 2-3 weeks. 

Radiographic features

Ultrasound

Ultrasound is typically the first-line investigation in suspected RPOC.

  • variable amount of echogenic or heterogeneous material within the endometrial cavity
  • presence of vascularity within the echogenic material supports the diagnosis, and helps to differentiate it from intrauterine blood clot
    • absence of color Doppler flow has a low negative predictive value, because RPOC may be avascular 9
  • calcifications may be present

RPOC can be suspected on ultrasound if the endometrial thickness is >10 mm following dilatation and curettage or spontaneous abortion (80% sensitive).

MRI

Retained products of conception can appear on MR imaging as an intra-cavitary uterine soft-tissue mass with variable amounts of enhancing tissue and variable degrees of myometrial thinning and obliteration of the junctional zone. 

Signal characteristics include:

  • T1: variable heterogenous signal 1
  • T2: variable heterogenous signal 1
  • T1 C+ (Gd): can show variable enhancement 

Differential diagnosis

For ultrasound appearances consider:

See also


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