Retained products of conception (RPOC) are where products of conception remain in the uterus after childbirth, abortion, or miscarriage. Products of conception are tissue derived from the union of an egg and sperm.
Classification
Missed miscarriage (aka delayed miscarriage), is when essentially no products of conception have passed
Incomplete miscarriage, is when some products have passed, but some still remain in utero
Ix
U/S
Tissue from a D&C, is analyzed → the presence of POC excludes an ectopic pregnancy
Tx
After an abortion, the presence of POC detected by U/S, is NOT an indication for surgical intervention (i.e. vacuum aspiration or D&C), as RPOC will be expelled during subsequent vaginal bleeding. Nonetheless, surgical intervention can be performed at the woman's request, if bleeding is heavy or prolonged, or causes anemia, or there is evidence of endometriosis
In missed miscarriage, following an U/S:
Gestational sac <15mm, corresponding to a gestational age <7 weeks, expectant Mx or drugs are preferred. The POC may be difficult to find surgically, with a considerable risk of failed surgery
Gestational sac 15-35mm, embryo<25mm (corresponding to 7-9 weeks gestation), drugs are recommended. Surgery or expected Mx may be considered
Gestational sac>30-35mm, embryo>25mm (corresponding to 9 weeks gestation), surgery is recommended, as there poses a high risk of pain and bleeding w/ passage of POC
In incomplete miscarriage, following an U/S:
RPOC<15mm, expected Mx is generally preferable, as there is a high chance of spontaneous expulsion
RPOC 15-20mm, drugs or expected Mx is recommended. Surgery should only be considered upon specific indication
RPOC >35mm, requires:
Misoprostol, to hasten passage of POC. If this fails, a pelvic exam should be done prior to considering surgical evacuation of the uterus, or the Pt leaving the hospital
Admission to inpatient care for observation (for a few hours/overnight) until the majority of POC has passed and bleeding subsided
See also
Ectopic pregnancy
Anembryonic gestation (blighted ovum) which doesn’t have a viable embryo, is a product of conception
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