What is the obstetric score of a patient with retained products after a Medical Termination of Pregnancy (MTP)?

Obstetric Scoring for a Patient with Retained Products After Medical Termination of Pregnancy (MTP)

For a patient with retained products after medical termination of pregnancy (MTP), the obstetric score should record this pregnancy as G_P_A_L_, where the abortion (A) component is increased by one to reflect the current MTP, regardless of whether products are retained.

Understanding Obstetric Scoring

• The standard obstetric scoring system uses the GPAL format (Gravidity, Parity, Abortion, Living children) 1
• Gravidity (G) counts all pregnancies, including the current one with retained products 1
• Parity (P) counts births ≥20 weeks gestation 1
• Abortion (A) counts all pregnancy losses <20 weeks, including:
  • Spontaneous abortions (miscarriages)
  • Medical terminations of pregnancy (MTPs)
  • Surgical terminations 1
• Living (L) counts current living children 1

Retained Products After MTP

• Retained products of conception (RPOC) refers to intrauterine tissue that persists after pregnancy termination, miscarriage, or delivery 2, 3
• The presence of retained products does not change the classification of the pregnancy event itself 1, 4
• A medical termination of pregnancy (MTP) is counted in the "A" (abortion) component regardless of whether products are retained 1

Clinical Implications

• Retained products after MTP are diagnosed by:
  • Transvaginal ultrasound showing intracavitary tissue with internal vascularity or persistent gestational sac 4, 5
  • Endometrial thickness >10mm with vascular flow suggesting retained tissue 4
• Management options include:
  • Medical management with misoprostol 6
  • Surgical evacuation (traditional D&C) 2, 7
  • Hysteroscopic removal for direct visualization 2, 7

Important Considerations

• The term "early pregnancy loss" (EPL) is the preferred terminology over "failure" when documenting pregnancy outcomes 1
• "Incomplete EPL" or "retained products of conception" (RPOC) are the preferred terms for describing retained tissue after pregnancy loss 1, 4
• Patients with history of cesarean delivery require careful evaluation as RPOC may represent undiagnosed placenta accreta spectrum disorder 4, 3

Documentation Best Practices

• Document the obstetric score with the current MTP included in the "A" component 1
• Include detailed description of retained products in the medical record, but this does not alter the basic obstetric scoring 1, 4
• For follow-up purposes, note that persistent bleeding or rising hCG levels after treatment warrant re-evaluation for persistent RPOC 4, 5