Hypervascular retained products of conception: dilemma of diagnosis and management
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20194396Keywords:
Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascuAbstract
Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage.
References
Sellmyer MA, Desser TS, Maturen KE, Jeffrey Jr RB, Kamaya A. Physiologic, histologic, and imaging features of retained products of conception. Radiographics. 2013;33(3):781-96.
Di Salvo D. Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 2003;22:69-89.
Ota Y, Watanabe H, Fukasawa I, Tanaka S, Kawatsu T, Oishi A, et al. Placenta accrete/increta: Review of ten cases and a case report. Arch Gynecol Obstet. 1999;263:69-72.
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty one year analysis. Am J Obstet Gynecol. 2005;192:1458-61.
Zalel Y, Cohen SB, Oren M. Sonohysterography for the diagnosis of residual trophoblastic tissue. J Ultrasound Med. 2001;20:877-81.
Alcázar C, Laparte C. The reliability of transvaginal ultrasonography to detect retained tissue after spontaneous first-trimester abortion, clinically thought to be complete ultrasound. Obstet Gynecol. 1995;6:126-9.
Kamaya A, Petrovitch I, Chen B. Retained products of conception: spectrum of color Doppler findings. J Ultrasound Med. 2009;28(8):1031-41.
Noonan JB, Coakley FV, Qayyum A. MR imaging of retained products of conception. AJR Am J Roentgenol. 2003;181(2):435-9.
Iraha, Yuko, Okada, Masahiro, Toguchi, Masafumi, et al. Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions. Jap J Radiol. 2017:36.
Fleming H, Ostör AG, Pickel H, Fortune DW. Arteriovenous malformations of the uterus. Obstet Gynecol. 1989;73(2):209-14.
Müngen E. Vascular abnormalities of the uterus: have we recently over-diagnosed them? Ultrasound Obstet Gynecol. 2003;21(6):529-31.
Mantolistas T, Hurley V, Gilford E. Uterine arteriovenous malformation, a rare cause of uterine haemorrhage. Aust N Z J Obstet Gynaecol. 1994;34:197-9.
Sugiyama T, Honda S, Kataoka A, Komai K, Izumi S, Yakushuji M. Diagnosis of uterine arteriovenous malformation by colour pulsed Doppler ultrasonography. Ultrasound Obstet Gynecol. 1996;8:359-60.
Mungen E, Yergok Y, Ertekin A, Ergür A, Uçmakli E, Aytaçlar S. Color Doppler sonographic features of uterine arteriovenous malformations: report of 2 cases. Ultrasound Obstet Gynecol. 1997;10(3):215.
Al-Mehaisen L, Al-Kuran O, Amarin ZO, Matalka I, Beitawi S, Muhtaseb A. Secondary postpartum hemorrhage following placental site vessel subinvolution: a case report. Arch Gynecol Obstet. 2008;278(6):585-7.
Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61(4):301-13.
Asherman JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Emp. 1948;55(1):23-30.
Aseeja V. Management of retained products of conception with marked vascularity. J Turk Ger Gynecol Assoc. 2012;13(3):212-4.
Beller U, Rosen R, Beckman E, Maskoff G, Berenstein A. Congenital arteriovenous malformation of the female pelvis, a gynaecological perspective. Am J Obstet Gynecol. 1988;159:1153-60.
Gaylis H, Levine E, van Dongen L, Katz I. Arteriovenous fistulas after gynaecological operations. Surg Gynecol Obstet. 1973;137(4):655-8.
Saxena N, Deshmukh P, Chauhan AR. Uterine artery embolization in the management of retained products of conception. JPGO. 2016;3:9.
Pron G, Mocarski E, Bennett J, Vilos G, Common A, Vanderburgh L, et al. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol. 2005;105(1):67-76.
Tulandi T, Salamah K. Fertility and uterine artery embolization. Obstet Gynecol. 2010;115(4):857-60.
Munetoshi A, Motofumi Y, Chihiro M, Tadahisa T, Yuko K. Hysteroscopic resection of retained products of conception after temporal laparoscopic uterine artery ligation. 2016;5(2):81-3.
Wong SF, Lam MH, Ho LC. Transvaginal sonography in the detection of retained products of conception after first-trimester spontaneous abortion. J Clin Ultrasound. 2002;30:428-32.
