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Retained products of conception — a retrospective analysis of 200 cases of surgical procedures for the diagnosis of residua postpartum
, 1, 1, 1, 1
Affiliations- 3rd Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
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Abstract
Objectives: Postpartum retained products of conception are a relatively rare diagnosis occurring in approximately 1% of cases after spontaneous deliveries and abortions. The most common clinical signs are bleeding and abdominal pain. The diagnosis is based on clinical signs and ultrasound examination.
Material and methods: Retrospective analysis of 200 surgical procedures for the diagnosis of residua postpartum obtained in 64 months. We correlated the method and accuracy of diagnosis with definitive histological findings.
Results: During 64 months, we performed 23 412 deliveries. The frequency of procedures for diagnosis of retained products of conception (RPOC) was 0.85%. Most (73.5%) of the D&C were performed within six weeks of delivery. Histologically, the correct diagnosis was confirmed in 62% (chorion + amniotic envelope). There was interestingly lower concordance of histologically confirmed RPOC in post-CS patients (only 42%). In women after spontaneous delivery of the placenta, the diagnosis of RPOC was confirmed by histological correlate in 63%, and the highest concordance occurred in women after manual removal of the placenta in 75%.
Conclusions: Concordance with histological findings of chorion or amnion was seen in 62% of cases; this means that the
incidence rate in our study was around 0.53%. The lowest concordance is after CS deliveries, 42%. D&C for RPOC should be performed after adequate clinical evaluation and in the knowledge of 38% false positivity. There is certainly more space for a conservative approach under appropriate clinical conditions, especially in patients after CS.
Abstract
Objectives: Postpartum retained products of conception are a relatively rare diagnosis occurring in approximately 1% of cases after spontaneous deliveries and abortions. The most common clinical signs are bleeding and abdominal pain. The diagnosis is based on clinical signs and ultrasound examination.
Material and methods: Retrospective analysis of 200 surgical procedures for the diagnosis of residua postpartum obtained in 64 months. We correlated the method and accuracy of diagnosis with definitive histological findings.
Results: During 64 months, we performed 23 412 deliveries. The frequency of procedures for diagnosis of retained products of conception (RPOC) was 0.85%. Most (73.5%) of the D&C were performed within six weeks of delivery. Histologically, the correct diagnosis was confirmed in 62% (chorion + amniotic envelope). There was interestingly lower concordance of histologically confirmed RPOC in post-CS patients (only 42%). In women after spontaneous delivery of the placenta, the diagnosis of RPOC was confirmed by histological correlate in 63%, and the highest concordance occurred in women after manual removal of the placenta in 75%.
Conclusions: Concordance with histological findings of chorion or amnion was seen in 62% of cases; this means that the
incidence rate in our study was around 0.53%. The lowest concordance is after CS deliveries, 42%. D&C for RPOC should be performed after adequate clinical evaluation and in the knowledge of 38% false positivity. There is certainly more space for a conservative approach under appropriate clinical conditions, especially in patients after CS.
Keywords
retained products of conception; D& C; hysteroscopic resection; manually removed placenta
About this articleTitle
Retained products of conception — a retrospective analysis of 200 cases of surgical procedures for the diagnosis of residua postpartum
Journal
Issue
Article type
Research paper
Pages
967-971
Published online
2023-07-11
Page views
550
Article views/downloads
622
DOI
Pubmed
Bibliographic record
Ginekol Pol 2023;94(12):967-971.
Keywords
retained products of conception
D&C
hysteroscopic resection
manually removed placenta
Authors
Petr Velebil
Lucie Hajkova Hympanova
Hynek Herman
Michal Emingr
Petr Krepelka
Jiri Hanacek
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