Skip to main content
Top
Published in: The Journal of Obstetrics and Gynecology of India 5/2023

24-10-2023 | Hysteroscopy | Review Article

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

Authors: Sushil Chawla, Rajesh Sharma

Published in: The Journal of Obstetrics and Gynecology of India | Issue 5/2023

Login to get access

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.
Literature
1.
go back to reference Intstitute G. Induced Abortion Worldwide Fact Sheet. New York: Guttmacher Intstitute; 2016. Intstitute G. Induced Abortion Worldwide Fact Sheet. New York: Guttmacher Intstitute; 2016.
2.
go back to reference Abortion care guideline ISBN 978-92-4-003948-3 (electronic version) ISBN 978-92-4-003949-0 (print version) © World Health Organization 2022 Abortion care guideline ISBN 978-92-4-003948-3 (electronic version) ISBN 978-92-4-003949-0 (print version) © World Health Organization 2022
3.
go back to reference "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 "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.
go back to reference 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.CrossRef 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.CrossRef
5.
go back to reference 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. 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.
6.
go back to reference 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.CrossRef 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.CrossRef
7.
go back to reference Tinelli AP, Haimovich S. Hysteroscopy. New York: Springer; 2017. Tinelli AP, Haimovich S. Hysteroscopy. New York: Springer; 2017.
8.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
9.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
10.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
11.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
12.
go back to reference 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. 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.
13.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
14.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
15.
go back to reference 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.PubMed 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.PubMed
16.
go back to reference 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 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
17.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
18.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
19.
20.
go back to reference 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. 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.
21.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
23.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
24.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
25.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
Retained Products of Conception (RPOC): Diagnosis, Complication & Management
Authors
Sushil Chawla
Rajesh Sharma
Publication date
24-10-2023
Publisher
Springer India
Published in
The Journal of Obstetrics and Gynecology of India / Issue 5/2023
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-023-01873-6

Other articles of this Issue 5/2023

The Journal of Obstetrics and Gynecology of India 5/2023 Go to the issue