From the Guidelines
Retained Products of Conception (RPOC) should be suspected in patients with persistent or heavy vaginal bleeding, particularly in the setting of delayed postpartum hemorrhage (PPH), as it is the second most common etiology for PPH after uterine atony. According to the study published in the Journal of the American College of Radiology in 2020 1, about 1% of third trimester deliveries are complicated by RPOC. The diagnosis of RPOC is crucial in determining whether surgical intervention is warranted.
Key signs and symptoms that may indicate RPOC include:
- Persistent or heavy vaginal bleeding
- Pelvic pain or cramping
- Uterus that remains enlarged
- Fever
- Foul-smelling vaginal discharge
- Elevated white blood cell count
The primary diagnostic tool for RPOC is ultrasound, which may show echogenic material within the endometrial cavity or increased vascularity on color Doppler 1. Management of RPOC typically involves surgical evacuation with suction curettage, although medical management with misoprostol may be considered in stable patients with minimal symptoms.
It is essential to note that RPOC can lead to complications like hemorrhage, infection, and intrauterine adhesions if left untreated. Therefore, prompt diagnosis and treatment are critical to prevent these complications and ensure the best possible outcome for the patient. As stated in the study 1, imaging may be helpful in diagnosing RPOC, especially in cases where uterine atony is not responsive to treatment.
From the Research
Suspecting Retained Products of Conception (RPOC)
There are no direct research papers provided to assist in answering this question. However, some studies mention the importance of considering various diagnoses in patients with abdominal pain, including those related to female reproductive organs.
- In patients with female reproductive organs, diagnoses such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion should be considered 2.
- A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting unusual causes of abdominal pain and to preventing needless morbidity and mortality 3.
- Imaging studies, such as ultrasonography and computed tomography, can aid in the diagnosis of various abdominal conditions, including those related to female reproductive organs 2, 4, 5.
Diagnostic Considerations
When evaluating patients with abdominal pain, it is essential to consider a broad range of potential diagnoses, including those related to female reproductive organs.
- Laboratory tests, such as complete blood count and C-reactive protein, may be helpful in diagnosing certain conditions, but their diagnostic value is limited 4, 5.
- Imaging studies, such as ultrasonography and computed tomography, can provide valuable information in diagnosing abdominal conditions, including those related to female reproductive organs 2, 4, 5.