Sonographic Findings of Vascular Signals for Retained Products of Conception in Women Following First-Trimester Termination of Pregnancy

OBJECTIVES

To evaluate the occurrence of retained products of conception (RPOC) after termination of pregnancy in the first trimester and to assess the vascular signals with transvaginal ultrasonography (TVUS) examination in the detection of retained products.

METHODS

A retrospective cohort study was performed using TVUS examination in patients following termination of pregnancy. In cases of RPOC, 3 scales of vascular signal were identified: type 1, no or small amount, spot flow signals; type 2, medium amount, strip-like flow signals; type 3, rich amount, circumferential-like flow signals. The correlation between vascular signals and placenta accreta spectrum (PAS) staging was proposed by sonography and histopathology findings.

RESULTS

The 3 vascular patterns were differently distributed within non-RPOC as well as RPOC patients with and without PAS: type 1 vascular signal detection rates of non-RPOC and RPOC were 97.8% (262/268) and 28.1% (18/64), respectively. Of 64 cases of RPOC, 48.4% (31/64) of the patients had type 2 vascular signals. Vascular signals were enhanced in RPOC with PAS patients whose diagnosis was confirmed by histopathology.

CONCLUSIONS

The vascularity (amount of flow), vascular pattern (spot, strip- or circumferential-like flow), and the flow penetrating myometrium were significant findings for distinguishing concomitant RPOC with and without PAS. Additionally, RPOC may contribute to PAS progression, or PAS and RPOC in coordination strengthen the observed vascular signals.

A Case of Placenta Accreta Infection Managed by Hysterectomy After Treatment for Retained Products of Conception With Uterine Artery Embolization and Hysteroscopy

Retained products of conception (RPOC) are frequently associated with previous cesarean section (C-section), abortion, and intrauterine operations, which may affect subsequent pregnancies. A 38-year-old female had a history of C-section and two abortions. After the second abortion, she underwent evacuation of RPOC and was treated with uterine artery embolization (UAE) and hysteroscopic resection. She became pregnant again and vaginally delivered an infant at full term. After delivery, RPOC was suspected on magnetic resonance imaging (MRI), but the patient was discharged for follow-up. She was rehospitalized with a diagnosis of infection and a placental remnant. Antibiotics did not improve the infection; therefore, she underwent a total hysterectomy. After the operation, signs of infection rapidly improved. The pathological diagnosis was placenta accreta. This case was considered a high-risk group for RPOC. In such rare and complicated cases, it is important to consider the possibility of recurrent RPOC and provide sufficient explanations before delivery for subsequent intensive management.

DNA analysis of partial hydatidiform mole revealing triandric monogynic tetraploidy

The authors present a case of a partial hydatidiform mole where DNA analysis (STR - short tandem repeat genotyping) showed a triandric monogynic tetraploid genome composition with a XXXY gonosomal complement. This genetic finding clinicopathologically correlates with a partial hydatidiform mole, although it is rare in comparison with the typical, diandric monogynic triploid partial moles. The genetic analysis definitively confirmed the suspected diagnosis of a partial mole. To exclude the possibility that molar pregnancy represented retained products of conception after elective pregnancy termination, STR profiles from molar pregnancy and previous products of conception were compared. Short tandem repeats genotyping is a useful molecular genetic method in the differential diagnosis of partial hydatidiform moles, where clinical-pathological findings are frequently ambiguous.

[Expectant therapy versus curettage for retained products of conception after second trimester termination of pregnancy: analysis of outcomes and complications]

OBJECTIVE

To evaluate the prognosis and complications of expectant therapy and curettage for retained product of conception (RPOC) after second trimester termination of pregnancy (TOP).

METHODS

A total of 270 patients with RPOC following second trimester TOP in Nanfang Hospital between January, 2014 and December, 2015 were included in this study. The duration of vaginal bleeding time and menstruation recovery interval were compared between patients receiving expectant therapy and curettage for RPOC, and binary logistic regression was used to assess the risk factors for complications in bivariate and multivariate analyses.

RESULTS

The duration of vaginal bleeding time was significantly longer in expectant therapy group than in curettage group (P=0.005), while the menstruation recovery interval did not differ significantly between the two groups. The incidence of vaginal bleeding time for over 42 days was significantly higher in curettage group than in expectant therapy group (P=0.040), and the incidence of a menstruation recovery interval beyond 60 days was comparable between them. The incidence of complications was significantly higher in curettage group than in expectant therapy group either with adjustment of age, gravidity, parity, history of uterine surgery status, gestational age, type of indications, regimens for TOP and induction-abortion interval (OR=18.26[95% CI: 3.57-93.42], P < 0.001) or without adjustment (OR=10.60, [95% CI: 2.36-47.66], P=0.002).

CONCLUSION

Expectant therapy and curettage for RPOC after second trimester TOP have comparable prognosis, but curettage is associated with a significantly higher rate of complications.