Managing patients with suspected postpartum retained products of conception using a novel sonographic classification. (March 2022)

• Record Type: Journal Article
• Authors: Levinsohn-Tavor, Orna; Sharon, Nataly Zilberman; Feldman, Noa; Svirsky, Ran; Smorgick, Noam; Nir-Yoffe, Arava; Maymon, Ron
• Is Part Of: Acta radiologica. Volume 63:Number 3(2022)
• Page Start: 410
• Page End: 415
• Publication Date: 2022-03
• Subjects: Classification -- postpartum -- retained products of conception -- ultrasound; Radiology, Medical -- Periodicals; Radiography, Medical -- Periodicals; Radiotherapy -- Periodicals; 616.0757
• DOI: 10.1177/0284185121991464
• Languages: English
• ISSNs: 0284-1851

Abstract

Background: Suspicion of retained products of conception (RPOC) often arises after delivery and still poses a diagnostic and management challenge. Purpose: To prospectively evaluate a sonographic classification for the management of patients with suspected RPOC after delivery. Material and Methods: Based on grayscale and Doppler ultrasound parameters, patients were classified into high, moderate, or low probability of RPOC. For the low and moderate probability groups, an ultrasound follow-up at the end of the puerperium was recommended. For the high probability group, a follow-up examination was conducted 10–14 days after the first ultrasound, and patients with persistent high probability findings were referred for surgical intervention. Results: The sample was composed of 215 patients at risk of RPOC. Of these, 100, 93, and 22 patients were classified as having a low, moderate, or high probability of RPOC, respectively. Rates of RPOC were 55%, 2%, and 2% in the high, moderate, and low probability categories, respectively. When the categorization was based on the most recent ultrasound obtained during the puerperium, the adjusted RPOC prevalence rates were 71% in the high, 6% in the moderate, and 0% in the low probability groups. Conclusion: This study confirms the effectiveness of our sonographic classification for managing patients with suspected RPOC after delivery. In all three categories, it is recommended to adhere to a conservative management protocol in clinically stable women until the end of the puerperium. This approach provides good predictability for RPOC and can reduce unnecessary surgical interventions.