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.
RPOC can complicate ~1% of all pregnancies. It occurs with greater frequency with:
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.
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).
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
For ultrasound appearances consider:
- blood clot within the endometrial cavity (often co-exists): non-vascular on colour Doppler ultrasound
- gestational trophoblastic disease
- uterine arteriovenous malformation (if prominent blood flow is present)
Ultrasound - obstetric
- ultrasound (introduction)
- obstetric ultrasound
first trimester and early pregnancy
- gestational sac
- yolk sac
- Beta-hCG levels
- ectopic pregnancy
- multiple gestations
- subchorionic hematoma
- failed early pregnancy
- nuchal translucency
- chorionic villus sampling (CVS) and amniocentesis
- second trimester
- first trimester and early pregnancy
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- 7. Sadan O, Golan A, Girtler O et-al. Role of sonography in the diagnosis of retained products of conception. J Ultrasound Med. 2004;23 (3): 371-4. J Ultrasound Med (full text) - Pubmed citation
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Synonyms & Alternative Spellings
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