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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. This 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 remains elevated in patients with gestational trophoblastic disease but falls to an undetectable level over 2-3 weeks in patients with retained products of conception. 

Radiographic features

Ultrasound

Ultrasound is typically the first-line investigation in suspected RPOC. It may demonstrate a variable amount of echogenic or heterogeneous material within the endometrial cavity. The presence of vascularity within this supports the diagnosis, and helps to differentiate it from intrauterine blood clot. Calcifications may be present.

RPOC can be suspected on ultrasound if the endometrial thickness is > 5 mm following dilatation and curettage or spontaneous abortion.

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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