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).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS