Retained products of conception
- Daniela A Carusi, MD, MSc
Daniela A Carusi, MD, MSc
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
The term retained products of conception (RPOC) refers to placental and/or fetal tissue that remains in the uterus after a spontaneous pregnancy loss (miscarriage), planned pregnancy termination, or preterm/term delivery. The presence of RPOC after a spontaneous pregnancy loss distinguishes an incomplete from a complete miscarriage.
This topic will review the evaluation and management of women who present with bleeding and/or signs of infection after uterine evacuation in the first half of pregnancy. Management of RPOC after preterm/term delivery and the initial management of an incomplete miscarriage are discussed separately. (See "Overview of postpartum hemorrhage" and "Postpartum endometritis" and "Spontaneous abortion: Management".)
The reported incidence of RPOC varies widely and depends on several factors, including initial treatment (higher with nonsurgical versus surgical management), criteria for diagnosis (signs/symptoms versus laboratory/pathology/imaging results), and duration of follow-up (RPOC often resorb or are passed) [1-17].
The characteristic clinical manifestations of RPOC include one or more of the following: uterine bleeding, pelvic pain, fever, and/or uterine tenderness. These clinical findings are nonspecific; moreover, it is normal to have some postabortal bleeding and discomfort.
Uterine bleeding — Women routinely have some uterine bleeding after a miscarriage or pregnancy termination, so it can be difficult to distinguish normal from abnormal bleeding. A reasonable approach is to assume that bleeding is probably abnormal if it is heavy (ie, has the potential to result in anemia [passage of large clots or flow that is significantly greater than menses, or not diminishing over time]) or prolonged (ie, lasting longer than three weeks).
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- CLINICAL MANIFESTATIONS
- Uterine bleeding
- Fever and/or pain
- DIFFERENTIAL DIAGNOSIS
- DIAGNOSTIC EVALUATION
- Physical examination
- Imaging studies
- - Sonohysterography
- Patients who are hemodynamically unstable
- Patients with sepsis
- Medically stable patients with endometritis
- Medically stable patients with prolonged bleeding
- - Surgical intervention
- - Medical intervention
- - Expectant management
- - Abnormal placentation
- SUMMARY AND RECOMMENDATIONS