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Retained Products of Conception (RPOC): Diagnosis, Complication & Management

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Abstract

Introduction

Retained products of conception (RPOC) generally result after first half of pregnancy termination and also may occur after vaginal or cesarean delivery. It frequently presents with irregular or continuous vaginal bleeding, lower abdominal and pelvic pain, and discharge per vaginum due to infection; it can also cause late complications like formation of intrauterine adhesions and subfertility. The diagnosis of the RPOC along with the symptoms is generally supported by ultrasonography with or without colour Doppler. The patient also undergoes uterine vasculature assessment to diagnose arteriovenous malformation (AVM). The management of RPOC has been conventionally done with blind dilation and suction curettage (D and C); however, expectant management, uterine artery embolization, and hysteroscopic resection of RPOC are safe and efficient alternatives.

Materials and methods

In this review, we analyse the current available evidence regarding the clinical presentation, diagnosis and treatment of RPOC comparing the sensitivity, specificity, outcomes, pros and cons of various methods.

Conclusion

RPOC is a common complication associated with early and late complications. The judicious use of antibiotics along with interventional radiology and hysteroscopy forms the backbone for the treatment of this condition.

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References

  1. Intstitute G. Induced Abortion Worldwide Fact Sheet. New York: Guttmacher Intstitute; 2016.

    Google Scholar 

  2. Abortion care guideline ISBN 978-92-4-003948-3 (electronic version) ISBN 978-92-4-003949-0 (print version) © World Health Organization 2022

  3. "MTP ACT, 1971 | Ministry of Health and Family Welfare | GOI". Ministry of Health and Family Welfare, Government of India. 10 August 1971. Archived from the original on 6 August 2022. Retrieved 23 July 2021

  4. Smorgick N, Mittler A, Ben-Ami I, et al. Retained products of conception: What is the risk for recurrence on subsequent pregnancies? Eur J Obst Gynecol Reprod Biol. 2018;24:1–5.

    Article  Google Scholar 

  5. Purshottaman V, Rosen EM, et al. Retained products of conception after early pregnancy loss: a closer look. Univ North Carol ASRM Abstr. 2020;114(3):e188.

    Google Scholar 

  6. Hame CC, van Wessel S, Carnegy A, et al. Systematic review diagnostic criteria for retained products of conception—a scoping review. Acta Obstet Gynecol Scand. 2021;100:2135–43.

    Article  Google Scholar 

  7. Tinelli AP, Haimovich S. Hysteroscopy. New York: Springer; 2017.

    Google Scholar 

  8. Smorgick N, Segal H, Eisenberg N, Dovev MN, Dvash S, Rabinovich I. Serum β-HCG level in women diagnosed as having retained products of conception: a prospective cohort study. J Minim Invasive Gynecol. 2022;29(3):424–8.

    Article  PubMed  Google Scholar 

  9. Capmas P, Lobersztajn A, Duminil L, et al. Operative hysteroscopy for retained products of conception: efficacy and subsequent fertility. J Gynecol Obstet Hum Reprod. 2019;48:151.

    Article  PubMed  Google Scholar 

  10. Fei Z, Xin X, Fei He, Yuechong C. Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage. Eur J Obstet Gynecol Reprod Biol. 2020;244:1–4.

    Article  CAS  PubMed  Google Scholar 

  11. Hamel C, Coppus S, van den Berg J, et al. Mifepristone followed by misoprostol compared with placebo followed by misoprostol as medical treatment for early pregnancy loss (the Triple M trial): a double-blind placebo-controlled randomised trial. EClinicalMedicine. 2021;32:100716.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Munros J, Gracia M, Nonell R, et al. Delayed hysteroscopic removal of retained products of conception is associated with spontaneous expulsion. SRL Reprod Med Gynecol. 2017;3:24–8.

    Google Scholar 

  13. Vyas S, Choi HH, Whetstone S, Jha P, Poder L, Shum DJ. Ultrasound features help identify patients who can undergo non-invasive management for suspected retained products of conception: a single institutional experience. Abdom Radiol (NY). 2021;46(6):2729–39.

    Article  PubMed  Google Scholar 

  14. Hamel CC, van Wessel S, Carnegy A, Coppus SFPJ, Snijders MPML, Clark J, Emanuel MH. Diagnostic criteria for retained products of conception-A scoping review. Acta Obstet Gynecol Scand. 2021;100(12):2135–43.

    Article  PubMed  Google Scholar 

  15. Alonso Pacheco L, Timmons D, Saad Naguib M, Carugno J. Hysteroscopic management of retained products of conception: a single center observational study. Facts Views Vis Obgyn. 2019;11(3):217–22.

    CAS  PubMed  Google Scholar 

  16. Melcer Y, Smorgick N, Schneider D, Pansky M, Halperin R, Ben-Ami I. Infertility following retained products of conception: Does the timing of surgical intervention matter? Isr Med Assoc J. 2016;18(10):605–8.

    PubMed  Google Scholar 

  17. Hooker AB, de Leeuw RA, Emanuel MH, et al. The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature. BMC Pregnancy Childbirth. 2022;22:837.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ishihara T, Kanasaki H, Oride A, Hara T, Kyo S. Differential diagnosis and management of placental polyp and uterine arteriovenous malformation: case reports and review of the literature. Womens Health (Lond). 2016;12(6):538–43.

    Article  PubMed  Google Scholar 

  19. Calzolari S, Cozzolino M, Castellacci E, et al. Hysteroscopic management of uterine arteriovenous malformation. JSLS. 2017;21(2):e2016.00109.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Karadag B, Erol O, Ozdemir O, et al. Successful treatment of uterine arteriovenous malformation due to uterine trauma. Case Rep Obstet Gynecol. 2016;1890650:3.

    Google Scholar 

  21. Rosen A, Chan WV, Matelski J, et al. Medical treatment of uterine arteriovenous malformation: a systematic review and meta-analysis. Fertil Steril. 2021;116(4):1107–16.

    Article  CAS  PubMed  Google Scholar 

  22. Takeda A, Koyama K, Imoto S, et al. Computed tomographic angiography in diagnosis and management of placental polyp with neovascularization. Arch Gynecol Obstet. 2010;281(5):823–8.

    Article  PubMed  Google Scholar 

  23. Nakashololo T, Khan N, Dunn Z, Snyman L, Ismail SMHI. Uterine arteriovenous malformations, clinical and radiological considerations: a report of two cases. Radiol Case Rep. 2021;16(7):1924–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kimura Y, Osuga K, Nagai K, Hongyo H, Tanaka K, Ono Y, Higashihara H, Matsuzaki S, Endo M, Kimura T, Tomiyama N. The efficacy of uterine artery embolization with gelatin sponge for retained products of conception with bleeding and future pregnancy outcomes. CVIR Endovasc. 2020;3(1):13.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Horo G, Aka K, Toure A, Koffi A, Seni K, Kone M. Endoscopy management of endometrial ossification associated with secondary infertility: a case report and review of literature. J Clin Gynecol Obstet. 2016;5(1):45–9.

    Article  Google Scholar 

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  1. INHS Asvini, Near RC Church Colaba, Mumbai, India

    Sushil Chawla & Rajesh Sharma

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  1. Sushil Chawla
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  2. Rajesh Sharma
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Correspondence to Sushil Chawla.

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Chawla, S., Sharma, R. Retained Products of Conception (RPOC): Diagnosis, Complication & Management. J Obstet Gynecol India 73, 374–380 (2023). https://doi.org/10.1007/s13224-023-01873-6

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