Retained Products of Conception(RPOC): Diagnosis, Complications and Management

Sushil Chawla¹ · Rajesh Sharma¹

Sushil Chawla chawla_sushil@rediffmail.com Rajesh Sharma drrajesh34@yahoo.in

1 INHS Asvini, Near RC Church Colaba, Mumbai, India

Introduction Retained products of conception (RPOC) generally results after first half of pregnancy termination and also may occur after the 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 with the symptoms is generally supported by ultrasonog- raphy 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 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.

Keywords : Retained products of conception · Hysteroscopy · Intrauterine adhesions · Uterine arteriovenous malformation

The residual trophoblastic tissue remaining within the uterine cavity after termination of pregnancy is known as retained product of conception (RPOC). It can occur after a miscarriage or termination of pregnancy or after delivery.

Abortion: Burden and Legal status

Miscarriage and induced abortions are prevalent and annually, 73 million viable first trimester pregnancies are terminated globally [1]. It is further estimated that 10–25% of the pregnancies end in miscarriage. Moreover, WHO estimates that 56 million abortions take place globally every year [2] Traditionally, WHO has defined unsafe abortion as ‘a procedure for termination of a pregnancy done by an individual who does not have the necessary training or in an environment not confirming to minimal medical standards. Unsafe abortions have been attributed in 4.7% to 13.2% of the maternal deaths and many of these unsafe abortions present with RPOC and its complications. In 2017, WHO replaced this dichotomous classification of abortions into safe and unsafe abortions to three tier classification of safe, less safe, and least safe abortions [3].

Abortion is legal in India. Legal restrictions have acted as a barrier to access safe abortion care resulting in amendment in the abortion laws of country. The cost of abortion care is covered by the Govt under Ayushman Bharat & Employee State Insurance schemes. On an average ten women die every day due to complications of unsafe abortion in India. A combined study by Guttmacher Institute New York, IIPS Mumbai and Population Council New Delhi estimated that 15.6 million abortions took place in India in year 2015. Only 22% of these abortions were performed within healthcare facilities. The study calculated the abortion rate of 47 abortions per 1000 women of the age group 15 to 49 years. Considering the quantum of global load of abortion and its complication, WHO formulated Abortion Care Guidelines 2022 to standardize abortion care worldwide [3].

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